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HX641 27923 
RC622  .B61  Attectivity,  suggest 


RECA 


Affectivity,     Suggestibility, 
Paranoia 


By 

Prof.   Dr.   E.    BLEULER, 

Professor  of  Psychiatry  at  the  University  of  Zurich 


Authorized  Translation  by 

Dr.  CHARLES  RICKSHER 

Assistant  in  Clinical  Psychiatry,  Psychiatric  Institute, 
New  York  State  Hospitals 


UTICA,  N.  Y. 

9TATE  HOSPITALS  PRESS 

1912 

[Reprint  from  N.  Y.  State  Hospitals  Bulletin,  February,  t9xa] 


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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

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http://www.archive.org/details/affectivitysuggeOObleu 


Affectivity,      Suggestibility, 
Paranoia 


By 

Prof.   Dr.   E.    BLEULER, 

Professor  of  Psychiatry  at  the  University  of  Zurich 


Authorized  Translation  by 

Dr.  CHARLES   RICKSHER, 

Assistant  in  Clinical  Psychiatry,  Psychiatric  Institute, 
New  York  State  Hospitals 


UT1CA.  N.  Y. 
STATE  HOSPITALS  PRESS 


[Reprint  from  N.  Y.  State  Hospitals  Bulletin,  February,  1912] 


AFFECTIVITY,   SUGGESTIBILITY,   PARANOIA. 

By  E.  Bleuler, 

Professor  of  Psychiatry,  Zurich-Burgholzli. 
TRANSLATED 

Bv  Charles  Ricksher,  M.  D., 

Assistant  in  Clinical  Psychiatry,  Psychiatric  Institute  of  the  New  York  State 
Hospitals  for  the  Insane,  Ward's  Island,  N.  Y.  City. 


AFFECTIVITY. 

Psychopathological  investigation  has  finally  reached  a 
point  where  we  can  go  no  further  with  the  ordinary  con- 
ceptions and  methods.  On  the  one  hand  new  conceptions 
must  be  created,  as  Krsepelin  has  done  in  his  experimental 
studies ;  on  the  other  hand,  our  general  concepts  and 
general  descriptive  terms  which  are  too  indefinite  and 
which  do  not  go  deep  enough  must  be  replaced  by  more 
exact  ones.  Confusion  and  stupor  for  example,  are  not 
terms  with  which  one  can  do  very  much  ;  one  must  know 
upon  which  of  many  possible  fundamental  derangements 
I  hallucinations  and  delusions,  flight  of  ideas,  katatonic 
parasthesias,  retardation,  blocking,  apathy,  etc.),  such 
disorders  depend  in  any  given  case. 

One  of  the  best  examples  of  how  one  may  get  lost  in  the 
unfathomable  by  working  with  obscure  ideas  is  shown  in 
the  pathology  of  paranoia,  and  the  attempt  to  explain 
delusions  by  disorders  of  the  emotions. 

Specht^  speaks  of  an  '  affect  of  suspicion  ' '  as  a  mixed 
affect"  of  pleasure  and  displeasure,  without  even  touching 
on  the  question  whether  suspicion  is  really  an  affect  in  the 
same  sense  as  pleasure  or  displeasure.  In  accordance  with 
his  conception  we  would  have  to  place  pathological 
suspiciousness  by  the  side  of  the  elated  mood  of  mania  and 
the  depressed  mood  of  melancholia,  whereas  daily  clinical 
observation  teaches  us  that  there  is  as  little  resemblance 

*  Specht.  Ueber  den  pathologischen  Affect  in  der  chronis'chen  Paranoia. 
Festschrift  der  Univ.  Erlangen  zur  Feier  des  80.  Geburtstages  seiner  Konigl. 
Hoheit  des  Prinzregenten  von  Bayern.     Erlangen,  Deichert,  1901. 


between  the  disorders  of  paranoia  (chronica;  and  those  of 
the  affective  psychoses  as  there  is  between  the  waves  of  a 
stream  raised  by  the  wind  and  the  current  of  the  stream. 

In  order  to  proceed  farther  it  will  be  necessary  to  attempt 
the  formulation  of  a  clear  conception  of  wThat  we  mean  by 
the  term  affectivity,  a  conception  with  which  we  can  oper- 
ate and  which  comprises  all  that  is  meant  by  the  terms 
"feeling,"  "mood,"  "affect,"  and  "emotion."  As  we 
shall  see  the  word  "feeling"  has  too  broad  a  significance, 
while  the  meanings  of  the  other  three  words  are  too 
narrow. 

Just  as  is  the  case  in  other  fields,  philosophical  psychology 
does  not  help  us  to  clearly  circumscribe  our  conceptions. 

The  Stoics  in  describing  the  feelings  as  "  indefinite  cogni- 
tions, ' '.  had  in  mind  something  which  in  most  text-books  on 
psychiatry  is  not  included  in  the  conception  of  feelings  ; 
they  thought  pre-eminently  of  intellectual  processes.  To 
the  scholastics  the  feelings  were  either  a  desire  for  the  good 
-or  an  aversion  to  the  bad,  in  other  words  pleasure  and  dis- 
pleasure, to  which  was  added  a  certain  ethical  value,  and  a 
special  emphasis  upon  the  voluntaristic  principle  which  is 
always  contained  in  the  "feelings."  If  Hegel  calls  feeling 
"intelligence  on  the  threshold  of  it's  immediateness,"  and 
Volkmar  ' '  the  becoming  conscious  of  the  degree  of  tension  of 
ideation, "  we  can  not  deny  that  these  are  words  which  mean 
little  more  than  nothing  to  the  practical  psychologist,  the 
psychopathologist ;  nor  are  we  any  better  off  when  we  take 
into  account  the  explanations  which  are  always  indispens- 
able for  the  understanding  of  such  "definitions."  Kant 
expressed  himself  most  clearly  and  correctly  on  this  subject, 
but  without  effect  upon  his  successors  however,  whose 
conceptions  are  not  much  clearer  than  those  of  the  earlier 
philosophers. 

In  the  general  part  of  the  text-books  on  psychiatry  we 
find  as  a  rule  fairly  clear  statements.  Here  pleasure  and 
displeasure  in  combination  with  the  affects  represent  the 
concept  to  which  we  refer.  But  not  infrequently  psychi- 
atrists go  beyond  this  concept,  the  limits  of  which  are 
regarded  as  self-evident  and  are  not  specifically  stated.     We 


thus  often  are  led  imperceptibly  to  "  feelings  of  security," 
to  "the  affect  of  suspicion,''  to  "  bodiry  feelings,"  etc. 

If  we  now  seek  to  define  in  a  practical  and  serviceable 
manner  the  idea  of  feeling,  mood,  emotion,  affect,  we  must 
keep  in  mind  the  fact  that  we  can  make  only  a  theoretical  and 
not  an  actual  distinction  between  the  different  qualities  which 
are  here  concerned.  Just  as  in  the  simplest  sensations  of 
light,  we  differentiate  between  the  quality  (color,  shade) 
the  intensity  and  the  saturation,  so  may  we  speak  of  pro- 
cesses of  knowledge  (intelligence),  of  feelings,  or  will,  al- 
though we  know  that  no  mental  process  exists  in  which  all 
three  are  not  combined,  even  if  now  one,  now  another  comes 
into  prominence. *  When  we  designate  a  process  as  affective, 
we  know  that  this  is  an  abstraction  just  as  much  as  a  color 
conceived  independently  of  its  intensity.  We  must  always 
remember,  however,  that  the  process  called  affect  has 
also  an  intellectual  and  a  volitional  side,  which  we  ignore 
as  irrelevant  in  a  given  case  ;  and  that  through  continual 
increase  in  importance  of  the  intellectual  and  subsidence  of 
the  affective  factor,  a  process  finally  results  which  we  must 
designate  as  (mainly)  intellectual.  The  same  may  be  said 
about  will.  We  can  not  expect  therefore  to  divide  mental 
Tiappenings  into  purely  intellectual,  purely  affective  and 
purely  will  processes,  but  only  into  principally  intellectual, 
principally  affective  and  principally  volitional,  while  we 
keep  in  mind  that  many  transitions  exist.  Theoretically, 
however,  we  must  keep  the  three  different  sides  as  widely 
apart  as,  for  example,  the  intensity  and  quality  of  a  color 
sensation. 

Like  all  psychological  expressions,  the  word  "  feeling" 
originally  designated  something  sensory  ;  it  was  synony- 
mous with  the  modern  "  sensation  "  and  this  meaning  un- 
fortunately yet  remains.  We  feel  a  prick,  feel  a  fly  crawl- 
ing over  the  face,  we  feel  cold,  or  we  have  a  "feeling" 
that  the  floor  shakes.  ' '  Feeling ' '  in  the  first  two  examples 
is    synonymous  with   "sensation,"   a   "feeling     cold"     is 

*H6ffding  (Lehrbuch  der  Psychologie,  2.  deutsche  Ausgabe,  VI.  A.  3)  has  ar- 
ranged a  scale  from  the  almost  pure  affective  common  feelings  to  the  almost  pure 
sensory  perceptions.    Lehmann  also,  according  to  Kiilpe,  makes  a  similar  scale. 


usually  a  rather  indefinite  feeling,  while  in  the  "feeling- that 
the  floor  shakes"  lies  a  doubt  as  to  the  correctness  of  the 
perception. >,: 

Thus  the  ambiguous  word  is  entirely  unsuitable  for  us. 
Instead  of  it  we  will  use  the  expression  "  Affectivity,'''' 
which  shall  not  only  designate  the  affect  in  the  traditional 
sense  of  the  word,  but  also  the  slight  feelings  or  feeling 
tones  of  pleasure  and  displeasure  which  accompany  all 
sorts  of  experiences. 

Thus  the  idea  of  our  theme  is  fairly  exactly  defined.  It 
will  occur  to  no  one  to  designate  the  feeling  of  a  prick,  the 
feeling  of  crawling  ants,  the  feeling  of  swaying,  by  the 
wTord  affectivity,  even  though  " afficere"  originally  had 
also  a  more  concrete  meaning. 

Difficulties  arise  only  with  the  more  physical  sensations. 
Sight,  hearing  and  also  taste  and  smell,  are  excluded  from 
the  idea  of  feeling  in  German  and  English ;  one  feels 
neither  light  nor  tone,  taste  nor  smell.  On  the  other  hand 
the  term  feeling  is  ordinarily  used  with  the  sense  of  touch 
and  the  other  senses  connected  with  the  skin  which  are  not 
yet  adequately  defined. 

It  will  be  easy  to  separate  from  affectivity  all  that  is 
perceived  or  felt  by  these  latter  senses.  But  with  the  inner 
somatic  sensations  and  with  pain  there  exists  a  certain 
difficulty  in  regard  to  which  we  must  attempt  to  get  some 
clearness. 

The  kinesthetic  sensations  (muscle  sensations,  joint 
sensations,  sensation  of  tension  of  the  skin,  ligaments, 
tendons,  etc.,)  areas  a  matter  of  course  only  mere  sensations 
and  have  nothing  to  do  directly  with  affectivity  ;  they  are 
analogous  to  the  sensations  of  light  and  sound  and  give  us- 
information  concerning  the  condition  of  the  outer  world,  to 
which  in  a  psychological  sense  the  body  belongs.  Or  if  the 
analogy  be  not  admitted  we  may  say  :  they  give  us  inform- 
ation of  the  condition  of  the  sensory  nerves  of  the  muscles, 
tendons,  and  joints  exactly  as  light  sensation  gives  us 
information  of  the  condition  of  the  retina. 

*  Other  lanjjua.^es  are  no  better  in  this  regard.  Fiihlen  in  German  refers  ta 
■sensation  and  perception  as  well  as  feeling'.  Le  sentiment  du  deja-vu  is  an 
intellectual  perception  process  just  as  the  German  Bekanntheitsgefuhl. 


But  the  condition  of  tension  of  the  muscles  has  a  special 
•connection  with  affectivity  :  certain  affects  produce  tension 
in  our  muscles,  others  relax  them,  or  the3r  cause  a  different 
distribution  of  tension  in  the  different  muscle  groups. 

Such  forms  and  combinations  of  sensations*  of  tension 
are  physical  accompaniments,  or  perhaps  better,  component 
parts  of  affectivity.  They  have  a  certain  value  as  regards 
the  position  of  our  body — the  amount  of  a  movement  must 
be  regulated  according  to  the  tension — but  these  sensations 
scarcely  enter  consciousness  as  such,  but  they  form,  for 
our  inner  perception,  only  a  component  of  the  affect  and 
are  scarcely  ever  perceived  independently. 

Similarly  palpitation  of  the  heart  is  primarily  a  sensation, 
a  perception.  Although  this  sensation  is  clear  and  well 
defined,  it  is  at  the  same  time  a  symptom  and  a  component 
part  of  fear,  of  anxiety,  or  of  joyful  surprise,  etc.  The 
same  may  be  said  of  the  sensation  of  heaviness  or  lightness 
about  the  heart. 

The  majority  of  physical  sensations  which  as  such  we  do 
not  understand  have  almost  no  cognitive  value.  To  be 
sure  we  can  ascertain  indirectly  that  all  our  functions  are 
registered  in  some  manner  b}^  the  brain,  and  have  an  influ- 
ence upon  the  mind,  but  our  conscious  self  has  not  learned 
to  so  interpret  the  incoming  stimuli  that  it  knows  when  the 
stomach  secretes  much  HC1,  when  the  liver  forms  this  or 
that  chemical  compound  in  greater  or  lesser  amount,  etc. 

Thus  we  can  scarcely  call  these  centripetal  functions 
sensations,  and  it  is  therefore  quite  natural  that  we  should 
still  speak  of  ''bodily  feelings."  Their  connection  with 
the  affects  is  a  double  one,  a  centripetal  (  active )  and  a 
certrifugal  (or  passive)  one.  All  bodity  sensations  actively 
influence  our  mood  and  even  our  affects.  Thus  the  depres- 
sion associated  with  disorders  of  the  stomach  is  well  known, 
a  small  panaritium  makes  us  irritable,  etc.  On  the  other 
hand  physical  functions  (the  heart,  vessels,  intestines, 
glands,  etc.  )  and  through  them  the  bodily  sensations  are 
influenced  b3r  affectivity.  As  far  as  we  become  conscious 
of  these   bodily  changes  we  are  concerned  with  a  cognitive 

*This  not  to  be  confused  with  the  psychical  tension-feelings  of  Wundt  which 
-*re  not  feelings  in  our  sense  but  perceptions  of  inner  conditions. 


process,  i.  e.,  with  something'  intellectual;  for  the  rest  they 
are  "  symptoms  "  of  the  affect. 

Hunger  and  thirst  are  often  reckoned  among  the  affects- 
or  at  an}-  rate  the  feelings.  They  are  composed  of  sensations 
(aching  in  the  stomach,  burning  in  the  pharynx,  sensations 
of  weakness  in  the  musculature  and  in  the  mental  appara- 
tus, etc.,)  and  feelings  of  displeasure,  associated  with  these 
sensations  as  well  as  with  the  general  condition.  The 
sensations  naturally  belong  to  the  cognitive  processes,  to- 
the  intellect  in  its  wider  sense,  while  the  feelings  of  dis- 
pleasure belong  to  affectivity. 

The  position  which  pain  occupies  is  not  entirely  clear  to- 
me. Is  it  essentially  a  sensation  or  an  affect?  Or  does  it, 
like  hunger,  belong  partly  to  each  ?  The  latter  seems  to  me 
to  be  the  most  probable.  At  any  rate  it  has  a  sensory 
component  or  we  could  not  localize  it.  Moreover  it  possesses, 
like  a  sensory  function,  special  tracts  in  the  spinal  cord  and 
brain  stem,  perhaps  even  in  the  periphery.  But  it  is  strik- 
ing how  diffuse  is  its  localization  in  the  cortex  and  that 
analgesia  or  hyperalgesia  may  so  readily  be  produced 
through  mental  influences.  It  is  for  intance  much  easier  to- 
produce  analgesia  than  anasthesia  by  suggestion. 

We  might  imagine  that  these  specific  sensations  of  pain 
are  accompanied  by  such  a  strong  feeling  of  displeasure  that 
the  latter  appears  as  the  most  important,  as  the  essential 
element,  so  that  this  most  frequent  kind  of  displeasure  has 
become  the  prototype  of  all  negative  affects,  and  we  speak 
in  a  figurative  sense,  of  mental  pain  and  of  painful  affects 
in  general. 

The  fact  that  displeasure,  as  it  seems,  may  sometimes  be 
separated  from  the  painful  affect  and  may  even  be  replaced 
by  a  pleasure,  also  speaks  for  a  parallel  between  pain  and 
hunger,  i.  c,  for  the  supposition  that  it  is  a  special  sensation 
with  an  unpleasant  feeling- tone.  With  slight  pains,  such 
for  instance  as  cause  one  to  touch  the  affected  spot  again 
and  again  (hollow  tooth),  it  often  appears  that  an  increase 
of  pain  within  certain  narrow  limits  may  be  connected  with 
a  feeling  of  pleasure.  Even  excluding  masochism,  we 
must  also  remember  that  there  are  pleasurable  sexual  pains. 


7 

Further  there  are  hysterical  patients  who  perceive  pain  as 
such  (who  are  therefore  not  analgesic)  and  in  whom  this 
pain  is  associated  with  pleasure.  The  amphichromatic 
tickle  and  the  positive  sexual  pleasure  also  show  a  similar 
combination  of  sensations  with  strong  affects. 

All  that  we  have  described  above  as  sensation,  or  broadly  as 
a  cognitive  process,  i.e.,  as  an  intellectual  function*  must  be 
sharply  separated  from  the  conception  of  affectivity . 

The  same  distinction  which  we  have  made  in  the  centri- 
petal, must  also  be  made  in  the  more  intracentral  processes. 
Indeed  Nahlowsky  long  ago  separated  the  "intellectual 
feelings"  from  the  affective  ones,  yet  not  so  clearly  that  his 
separation  was  generally  understood. t  He  understood  by 
intellectual  feelings,  indefinite  perceptions,  conclusions  and 
ideas  which  influence  our  actions.  These  act  only  cumula- 
tively and  therefore  without  becoming  clear.  According 
to  him  we  appeal  to  these  "feelings"  only  when  we  lack 
sufficient  ground  for  a  view,  assertion  or  conclusion,  or 
when  we  know  the  grounds  in  a  general  way  but  are  unable 
to  produce  them  individually  and  in  logical  sequence.  Thus 
wo'men,  according  to  Nahlowsky,  are  usually  led  to  their 
views  and  conclusions  by  such  feelings. 

Nahlowsky  therefore  in  speaking  of  intellectual  feelings 
has  in  mind  conclusions  the  premises  of  which  or  the 
chain  of  logical  reasons  of  which  remain  partly  or  wholly 
subconscious. 

Such  conclusions  and  ideas  which  lack  a  clear  back- 
ground are  very  common  and  play  an  important  part  in 
life,  and  it  is,  for  example,  quite  true  that  women  often  allow 
their  actions  to  be  governed  more  by  such  "feelings  "  than 
by  conscious  reasoning.     I  may  have  the  feeling  that  such 

*  According  to  Wundt  "objective"  process  is  opposed  to  "subjective"  feeling'. 

t  Others  (Wundt,  Ziehen)  call  "  intellectual  feelings  "  such  feelings  and  affects 
as  accompany  composite  intellectual  processes,  in  contradistinction  to  "sensory- 
feelings."  Thus  employed  the  term  naturally  expresses  an  entirely  different  idea 
from  that  of  Nahlowsky's  terminology,  whose  conception  of  "intellectual  feel- 
ings" we  shall  often  have  occasion  to  use. 

The  French  also  (P.  Janet,  for  example)  speak  of  " sentiments  intellectuals" 
by  which  among  other  things  are  understood  :  sentiments  du  deja  vu,  du 
jamais  vu,  de  nouvaute,  d'etrangete,  d'incompletude,  and  even  de  cicile.  The 
idea  here  also  is  broader  than  with  us  and  has  as  little  to  do  directly  with 
affectivity  as  that  which  we  designate  by  the  name  of  intellectual  feelings. 


s 

a  person's  wishes  are  against  me,  or  that  X  is  a  rascal 
or  a  fine  fellow,  or  I  may  have  a  feeling  that  a  patient 
has  typhoid  fever.  But  in  none  of  these  examples  do 
I  know  why  I  have  this  feeling.  I  would  be  unable 
to  prove  its  correctness,  though  I  may  add  that  I  make 
fewer  mistakes  in  my  preliminary  judgments  about  per- 
sons if  I  follow  my  instincts  than  if  I  try  to  follow  my 
conscious  reasoning. 

All  these  are  examples  of  ' '  intellectual  feelings ; '  in 
Xahlowsky's  sense.  But  we  must  get  a  more  comprehen- 
sive idea  without  deciding  whether  we  then  depart  from  the 
authors  or  not. 

The  majority  of  psychologists,  including  Xahlowsky, 
conceive  of  feelings"  as  a  species  of  reactions  of  our 
mind  to  an}-  process,  especialh^  one  of  a  centripetal  char- 
acter. Such  reactions  may  naturally  be  intellectual  as  well 
as  affective.  Thus  Lipps*  describes  a  purely  intellectual 
process  when  he  says.  ' '  I  feel  certain  ' '  or  when  he  speaks 
of  the  ''feeling  of  certainty."  He  expresses  by  the  word 
"feeling''  the  knowledge  that  he  thinks  or  understands 
correctly.  This  cognition  may' be  accompanied  by  a  feel- 
ing of  pleasure  or  displeasure,  according  to  the  content  of 
the  thought  I  I  am  certain  that  my  friend  deceives  me  or  I 
am  certain  that  I  will  be  promoted  I .  Here  affectivity  is 
something  entirely  incidental.  The  "affect  of  suspicious- 
ness "  as  used  by  psychiatrists  is  somewhat  different.  This 
expression  does  not  signify  that  I  have  a  feeling  or  inner 
perception,  for  example,  of  being  suspicious,  but  rather  a 
feeling  that  perhaps  some  one  may  do  me  an  injury,  in 
other  words  simply  an  indefinite  idea  which  according  to  its 
content  is  accompanied  by  more  or  less  feeling-tone.  The 
corresponding  affect  need  not  always  be  negative.  Thus, 
for  example,  if  in  his  attack  my  opponent  gives  me  an  op- 
portunity to  render  him  harmless,  or  if  suspicion  seems  to 
be  directed  not  toward  me  but  toward  my  enenw,  the  affect 
is  positive. 

The  same  may  be  said  about  the  "feeling  of  truth  "  and 
the  "  feeling  of  probability  ";    of  which   Lipps   speaks.     If 

*Lipps.     Voni  Fillilen,  Wollen  and  Denfcen,  Leipzig,  Barth.  1002. 


we  recognize  or  logically  conclude  that  something'  is  true  or 
probable,  this  is  a  purely  intellectual  process,  and  it  is  the 
same  when  we  become  conscious  of  knowing  something  to 
be  sure  or  probable,  i.  c,  when  we  have  the  conscious  feel- 
ing of  certainty  or  of  probability. 

There  is  great  confusion  also  in  the  example,  '  T  feel  sad, ' ' 
which  Lipps  mentions.  While  this  seems  to  be  essentially 
an  affect,  the  expression  indicates  in  reality  only  the  process 
of  inner  cognition,  the  perception  that  we  are  sad,  the  ap- 
preciation of  the  inner  condition,  the  consciousness  of  sad- 
ness. That  which  is  described  by  the  word  '  'feel"  here  would 
remain  exactly  the  same  whether  I  felt  happy  or  sad,  just 
as  the  perceptive  process  as  such  is  the  same  whether  I  see 
a  cat  or  a  dog. 

All  this  we  designate  as  intellectual  feeling,  not  only 
because  the  expression  was  coined  for  it  b\r  Nahlowsky, 
but  also  because  the  uses  of  speech  stubbornly  designate  it 
as  feeling.  But  we  must  clearly  remember  that  this  sort  of 
feeling  has  nothing  to  do  with  affectivity  but  represents 
intellectual  (  objective)  processes.  To  repeat :  "  Intellectual 
feelings"  are  for  one  thing  indefinite  perceptions,  con- 
clusions and  ideas,  as  in  the  above  example  when  we  feel  that 
a  patient  has  typhoid  without  being  able  to  explain  why  ; 
and  they  are  also  inner  perceptions,  as  in  the  case  of  the 
"feeling  of  certainty."  These  two  kinds  of  intellectual 
feelings  can  not  be  so  easily  separated  practically  as  one 
might  theoretically  expect.  For  example,  we  speak  usually 
of  a  "  feeling  of  certainty  "  when  it  rests  on  an  indefinite 
conclusion  or  perception  ;  although  the  expression  as  such 
would  designate  rather  an  inner  perception,  it  is  as  a  rule 
only  used  when  it  comprises,  at  the  same  time,  an  indefinite 
cognition. 

These  intellectual  feelings  under  certain  conditions  play 
a  great  role  when  combined  with  affects.  I  have  already 
pointed  out  that  women  commonly  act  according  to  their 
intellectual  feelings.  We  must  not  forget  that  in  our  ordin- 
ary decisions  of  life  we  seldom  have  a  chance  to  make  all 
the  motives  of  our  acts  clear  to  ourselves.  In  a  discussion 
we  scarcely  have  time  to  grasp  our  opponent's  point  of  view 


10 

in  all  its  details  and  to  make  it  clear  to  ourselves  which  of 
the  many  possible  ways  is  the  best  to  overcome  him.  We 
reply  in  an  irritated,  friendly  or  deferential  manner  accord- 
ing- to  our  intellectual  feelings.  Shyness,  a  mixture  of 
indefinite  cognition  that  someone  might  do  someihing 
harmful  or  injurious  to  him,  and  the  affects  which  are 
associated  with  this,  sometimes  completely  control  the  con- 
duct and  thoughts  of  a  child,  etc.  On  the  other  hand  we 
find  that  under  certain  circumstances  the  feelings  with  their 
inhibitions  and  promptings  seem  to  take  the  place  of  logical 
thinking  almost  entirely,  so  that  the  conduct  becomes  purely 
instinctive.  (Compare  the  examples  of  such  reactions  in 
children  detailed  later  on). 

To  sum  up  we  may  add  that  the  word  "feeling"  means 
not  only  in  common  speech  but  also  in  psychology  many 
different  things  such  as  : 

1.  A  large  number  of  contripetal  processes,  sensations, 
perceptions  (feelings  of  warmth,  bodily  feelings). 

2.  Intracentral  perceptive  processes: 

a — With  reference  to  occurrences  outside  the  body, 
(  feelings  of  certainty,  of  probability). 

b — With  reference  to  the  internal  conditions,  (feelings 
of  sadness  ;  sentiment  de  cecite). 

3.  Indefinite  or  unclear  cognitions,  whether  it  be  direct 
perception  or  a  conclusion  the  elements  of  which  are  un- 
clear or  subconscious.  (  2  and  3  are  united  under  the  name 
intellectual  feelings  ). 

4.  The  feelings  of  pleasure  and  displeasure,  to  which  we 
must  add  the  affects,  the  affectivity. 

1 — 3  ARE  INTELLECTUAL  PROCESSES  WHICH  ARE  EN- 
TIRELY DIFFERENT  FROM  AFFECTIVITY  AND  SHOULD  NOT 
BE  CLASSED  WITH    IT. 

This  is  not  merely  an  academic  separation.  It  is  neces- 
sary in  order  to  study  the  mode  of  action  of  affectivity,  and 

IT  IS  ONLY  AFFECTIVITY  IN  THIS  NARROW  SENSE  THAT 
HAS  DEFINITE    EFFECTS   UPON  THE  BODY  AND  MIND.       The 

other  functions  separated  from  it  signify  in  themselves  only 
some  other  definite  or  uncertain  cognitions. 


11 

Whether  I  ' '  feel ' '  my  intestines  or  not,  whether  I  have 
a  feeling  of  "certainty"  or  of  "suspicion,"  this  is  all  com- 
paratively irrelevant  to  my  mind  so  long-  as  no  affect  is 
associated  with  these  feelings.  As  soon  as  an  affect  is 
added,  it  immediately  dominates  the  whole  mind. 

It  would  carry  us  too  far  to  attempt  an  enumeration  of 
all  the  modes  of  action  of  affectivity.  I  should  like  to 
cite  here  only  a  few  that  are  practically  important. 

Let  us  take  the  reaction  of  an  amoeba  quite  independently 
of  the  question  whether  its  functions  are  accompanied  by 
consciousness  or  not. 

The  stimulus  of  a  particle  of  food  acts  upon  a  certain 
definite  spot  of  its  body,  a  pseudopodium  is  sent  out  which- 
surrounds  the  food,  digests  it,  throws  out  the  indigestible 
part  and  again  the  amoeba  takes  its  original  form.  That 
would  be  the  localized  ' '  objective, "  "  intellectual"  process. 
But  the  nutritional  tonus  and  the  entire  condition  of  the 
amoeba  must  also  have  changed.  During  the  seizure  of 
the  food  other  parts  of  the  body  should  not  reach  out  in 
other  directions,  and  such  efforts  had  to  be  inhibited.  The 
taking  of  food  benefits  the  whole  individual;  it  grows 
stronger,  becomes  more  prone  to  fission  and  to  carry  out 
other  similar  functions,  and  the  general  mobility  of  the- 
granules'becomes  livelier,  etc.  These  general  reactions  of 
the  amoeba  may  be  compared  to  affectivity.  Naturally 
such  general  reactions  accompany  not  only  the  act  of 
seizure  and  digestion  of  the  food,  but,  as  in  the  higher 
animals,  they  must  begin  when  the  food-stuffs  became 
noticeable,  during  the  act  of  perception,  if  we  dare  use  here 
a  term  which  assumes  the  existence  of  consciousness. 

In  man  numerous  physical  phenomena  are  associated 
with  an  affect  (conditions  of  heart,  vasomotors,  muscle- 
tonus,  metabolism,  tear  glands,  intestinal  glands,  sweat 
glands,  the  entire  involuntary  musculature,  etc.).  Much 
more  important,  however,  are  the  psychical  accompan- 
iments. 

An  affect  generalizes  a  reaction,  or  we  may  express  it 
quite  as  correctly  by  saying:  An  affect  is  a  generalized' 
reaction. 


12 

A  prick  in  my  finger  causes  me  to  withdraw  the  hand.  If 
I  am  frightened  by  it,  I  run  away;  if  I  become  angry,  then 
I  attack.  But  it  is  not  only  the  body  which  is  influenced. 
If  I  am  alarmed,  because  the  prick  may  remind  me  of  a 
snake,  then  all  considerations  which  might  hinder  nry  flight 
become  more  or  less  repressed  and  the  thought  of  avoiding 
danger  becomes  the  dominant  one.  If  I  become  angry  I 
may  strike  out  even  though  it  may  not  be  the  wisest  thing 
to  do;  yet  I  am  quite  convinced  at  the  time  that  I  am 
warranted  in  so  doing.  Thus  in  the  presence  of  an  affect 
all  opposing"  associations  are  inhibited,  whereas  those  in 
harmony  with  the  affect  are  facilitated.*  The  momentary 
force  of  our  actions  is  thereby  naturally  increased  (even 
when  the  actions  are  negative,  such  as  a  persistence  in  a 
given  condition). 

It  is  easily  understood  that  associations  which  do  not 
harmonize  with  an  affect  can  not  all  be  entirely  suppressed. 
If  they  are  of  an  indifferent  nature,  the  affect  is  readily 
transferred  to  them.  The  place  where  something  unpleas- 
ant has  happened  to  us  is  hated.  We  often  hate  not  only 
the  one  who  does  us  an  injury  but  also  accidental  bystand- 
ers, and  this  feeling  may  remain  connected  with  them  for  a 
long  time  or  forever.  The  carrier  of  a  bad  message  is 
hated. 

Through  this  transference  of  the  affect  (irradiation.)  its 
influence  upon  actions  naturaby  becomes  further  increased 
and  deviations  from  the  course  taken  are  opposed  as  much 
as  possible. 

The  affects  have  the  further  peculiarity  of  lasting  longer 
than  the  actual  experience.  A  pleasant  experience  tends 
to  leave  an  agreeable  mood  for  a  long  time.  Anger  often 
increases  to  fury  some  time  after  an  unpleasant  occurrence. 

*The  Emotions  and  the  Will,  by  Alex.  Bain.  3rd  Edition.  1875.  "  The  influence 
of  feeling  on  belief  is  of  a  mixed  character.  In  the  first  place  it  would  arise  in 
the  ordinary  action  of  the  will.  We  are  not  easily  persuaded  of  the  ill  effects  of 
anything  we  like.  In  a  state  of  strong  excitement,  no  thoughts  are  allowed  to 
present  themselves  except  such  as  occur  in  the  present  mood.  Our  feelings 
pervert  our  convictions  by  smiting  us  with  intellectual  blindness,  which  we 
need  not  be  under  even  when  committing  great  imprudence  in  action.  It 
depends  upon  many  circumstances  what  intensity  of  emotion  shall  be  required 
to  produce  this  higher  effect  of  keeping  utterly  back  the  faintest  recollection  of 
whatever  discords  with  the  reigning  fury." 


13 

Whoever  has  seen  something"  worth  striving-  for  which 
has  excited  his  affects,  will  endeavor  to  gain  it,  even  when 
the  object  has  been  removed ;  and  the  duration  of  his  effort 
will  have  a  definite  and  direct  relation  to  the  strength  of 
the  affects.  In  this  way  affectivity  determines  perseverance 
in  our  actions. 

The  hindrance  to  free  judgment  brought  about  by  affects 
may  often  seem  to  be  more  disadvantageous  than  useful. 
Decisions  made  under  the  influence  of  emotion  are  rightly 
looked  upon  as  questionable.  I^or  instance,  one  does  many 
foolish  things  in  anger,  in  despair,  and  in  love,  which  he 
would  not  do  under  other  circumstances.  Even  negative 
affects,  like  fright  and  anxiety,  may  render  us  defenseless  to 
danger.  These,  however,  are  exceptions  which  are,  rela- 
tively, very  infrequent.  Still,  even  these  maximal  affects, 
which  often  overstep  the  mark,  may  be  at  times  of  advan- 
tage, as  is  the  case  with  the  strength  of  desperation.  The 
affects  which  are  well  adapted  to  our  needs  are  those  which 
occur  constantly  and  which  are  of  moderate  degree  ;  they 
are  as  a  rule  scarcely  noticed.  How  often  does  a  little  im- 
patience help  us  over  a  difficulty?  An  irritable  tone  of 
voice  often  suffices  to  get  rid  of  disturbing  persons. 
Children  who  often  do  not  know  what  danger  is,  would  be 
lost  as  soon  as  they  left  their  mother's  arms  if  anxiety 
caused  by  unknown  and  indefinite  perceptions  did  not  keep 
them  from  harmful  actions. 

And  in  important  matters  too  it  is  our  affectivity  which 
overcomes  the  obstacles.  Suppose  we  are  facing  a  difficult 
undertaking  ;  so  long  as  we  view  it  coldly  we  can  not 
resolve  to  take  hold  of  it;  the  obstacles  seem  to  be  too  great, 
too  many  considerations  must  be  put  aside.  But  when 
suddenly  our  enthusiasm  is  aroused  for  the  task,  then  it 
seems  to  be  the  only  thing  worth  working  for;  all  other 
considerations  are  forgotten  or  at  any  rate  put  aside  ;  all 
mental  and  physical  strength  is  set  to  work  for  the  one 
object.  Then  and  only  then  is  it  possible  to  gain  what  we 
desire. 

Affectivity,  therefore,  far  more  than  reflection,  is  the 
determining  element  in  our  acts  and  omissions.     Probably 


14 

we  act  exclusively  under  the  influence  of  feelings  of 
pleasure  and  displeasure.  Our  logical  processes  derive 
their  dynamic  force  only  from  the  affects  combined  with 
them.*  There  are  many  people  who  know  exactly  what 
they  should  do,  but  who  do  nothing  because  they  lack  the 
proper  affects.  All  instincts  so  far  as  we  can  observe  them 
in  ourselves,  or  analyze  them  in  lower  animals,  are  asso- 
ciated with  affects.  Hence  the  affects  are  connected  not 
only  with  cognition  but  even  more  closely  with  volition.  I 
might  better  say  that  affectivity  is  the  broader  conception 
wherein  volition  and  desire  represe?it  only  one  side.  Affectivity, 
which  is  one  with  our  instincts  and  impulses,  deter- 
mines the  direction  of  our  endeavors.  Logic,  judgment, 
seems  on  careful  examination  to  be  only  the  servant  that 
shows  the  way  to  the  goal  and  furnishes  the  necessary 
apparatus.  '  Harry  Campbell  says  rightly  that  men  preach 
what  they  think,  but  they  do  what  they  feel.  It  is  self- 
evident  that  the  moral  worth  of  a  man  depends  entirely 
upon  his  moral  feelings.  He  to  whom  the  good  does  not 
appear  beautiful  and  agreeable,  who  has  no  abhorrence  of 
the  bad,  who  lacks  sympathy,  will  act  badly,  even  though 
his  logic  under  special  or  general  circumstances  surely 
warns  him  that  it  would  be  better  for  him  to  behave  him- 
self (moral  idioc}7). 

On  the  whole  we  are  always  striving  for  experiences 
accompanied  by  agreeable  affects  and  we  avoid  the  opposite 
as  much  as  possible.  Conflicts  often  arise  from  the  fact 
that  the  attainment  of  one  pleasure  often  excludes  the  win- 
ning of  another,  that  one  of  two  evils  must  be  chosen, 
that  often  that  which  is  now  agreeable  will  be  disagreeable 
in  the  future.  All  these  and  other  similar  propositions  are 
well  known  common-places. 


*  In  psychopathology  the  affects  in  the  vast  majority  of  cases  are  the  index  of 
the  whole  picture,  and  it  is  easy  to  reduce  the  disorder  to  them,  as,  for  instance, 
in  melancholia  and  mania.  In  dementia  praecox,  where  the  affectivity  is  inter- 
fered with,  there  is  a  lack  of  effort,  a  failure  to  try  to  overcome  obstacles,  even 
when  the  intelligence  is  not  much  injured. 


15 

It  is  remarkable  how  little  attention  has  been  paid  to  the 
mechanisms  which  allow  ns,  through  influence  upon  mental 
processes,  to  render  affective  experiences  as  pleasant  or  as 
little  unpleasant  as  possible.  The  more  intelligent  and 
cultivated  a  man  is  the  less  does  he  live  in  the  present,  and 
the  more  important  do  the  past  and  future  become. 

The  past  remains  a  part  of  our  Ego  and  forces  us  to  come 
to  an  agreement  with  it.  We  rejoice  over  past  happiness, 
grieve  over  the  injustice  we  have  suffered,  and  the  evil 
things  we  have  done  torment  us  as  remorse  and  force  us  to 
atone. 

The  future  rules  us  even  more  distinctly  and  more  con- 
stantly. Anxiety  and  hope  determine  a  great  part  of  our 
present  acts.  They  even  go  beyond  the  grave  in  the 
endeavor  to  secure  a  place  in  heaven.  They  go  beyond  the 
future  when  unselfish  solicitude  for  those  we  leave  behind 
guides  our  acts.  Generally  speaking,  however,  we  try  to 
form  for  ourselves  a  future  with  as  many  comforts  and  as 
few  discomforts  as  possible,  and  to  this  we  devote  the 
greater  part  of  our  energies. 

In  pathological  conditions  and  in  dreams,  anticipated 
feelings  attain  special  significance,  since  in  wish-dreams 
and  in  wish-deliria,  which  latter  are  frequent  not  alone  in 
hysterical  states,  they  present  the  fulfillment  of  desires. 
For  example,  a  woman  in  love  may  dream  or  imagine  in  a 
delirium  that  she  is  the  wife  of  her  beloved.* 

There  are  also  wish-hysterias,  besides  delirious  conditions, 
which  represent  a  fictitious  wish  fulfillment.  The  wish 
may  then  become  fully  realized.  A  prisoner,  for  example, 
under  indictment  who  is  more  or  less  clearly  convinced  that 
it  would  be  well  for  him  to  be  declared  insane,  may  acquire 
a  mental  disorder,  but  a  mental  disorder  as  he  understands 
it  (Ganser's  complex ).f 

A  very  altruistic  woman  is  fired  with  a  desire  for  political 
progress.    Neither  her  strength  nor  her  circumstances  allow 

*The  influence  of  affectivity  on  the  mechanism  of  the  normal  and  abnormal 
mind  has  first  been  shown  in  its  proper  light  by  Freud. 

t  Compare  the  beautiful  case  of  Jung  {Jour,  fur Psychologie  and  Neurologie^ 
IQ03).  An  originally  voluntary  simulation  has  gotten  beyond  the  control  of  the 
patient  and  has  become  an  involuntary  delirium. 


16 

lier  to  carry  out  her  ideals;  nevertheless  she  must  talk 
about  thern  and  become  enthusiastic  over  them.  The  con- 
trast between  what  she  says  and  what  she  does,  between 
her  ideals  and  the  realities,  would  render  her  ridiculous;  but 
she  would  avoid  this  if  she  became  ill.  So  on  the  occasion 
of  an  unhappy  love  affair  she  acquires  hysterical  attacks, 
hj'-sterical  deliria,  which  naturally  resist  all  treatment,  since 
a  causal  treatment,  the  removal  of  the  above-described 
conflict,  is  not  likely  to  be  effected  for  a  longtime.  This 
"flight  into  disease"  is  a  very  frequent  cause  of  hysteria.* 

A  student  in  the  gymnasium  who  would  like  to  be 
among  the  best  pupils  is  overwhelmed  with  work.  If  he 
should  have  a  headache,  like  his  comrades  A  and  B,  the 
properly  completed  exercises  might  not  be  required  of  him. 
So  he  acquires  a  headache,  but  it  is  real  and  very  unpleas- 
ant, and  it  only  leaves  him  a  short  time  after  it  has  ceased 
to  be  useful  to  him. 

The  father  of  a  family  suffers  an  injury  in  a  railroad 
accident.  How  dreadful  if  he  should  no  longer  be  able  to 
provide  for  his  family!  At  present  he  is  doing  fairly  well, 
but  such  things  can  subsequently  grow  worse  as  well  as 
better.  And  suppose  he  should  have  to  go  on  with  his 
occupation  half  able  to  work  and  always  in  pain  ?  After  a 
late  turn  for  the  worse,  no  one  would  connect  it  with  the 
injury.  It  would  be  better  if  he  were  dead — or  totally 
disabled.  The  lawyer  tells  him  that  his  income  capitalized 
would  amount  to  80,000  frs,  and  he  could  demand  as  much 
in  case  he  were  incapacitated.  His  family  might  thus  be 
provided  for  permanently.  Does  not  everything  point  to» 
the  fact  that  he  will  need  to  have  this  money?  His  sleep  is 
already  irregular,  his  work  taxes  him  to  the  utmost,  pressure 
on  the  head  appears,  the  railroad  travel  required  by  his 
business  causes  anxious  dread,  even  anxious  seizures. 
How  very  necessary  it  is  to  prove  the  existence  of  a  severe 
disorder  and  obtain  the  80,000  frs.,  etc.  !  The  traumatic 
neurosis  or  psychosis  is  now  established  and  at  best  can 
only  be  cured  after  a  favorable  settlement  of  the  suit. 

All  these  ll  wishes"  here  referred  to  are  naturally  not  clearly 

*  This  "flight  into  disease"  has  been  very  well  described  by  Selma  Heine  in. 
her  novel  "  Peter  Paul,''  although  in  an  individual  who  was  not  hysterical. 


17 

conscious  to  the  individual.  The  mechanism  of  their  realiza- 
tion is  wholly  outside  of  his  knowledge.  His  acts  are  bona 
fide. 

We  have  now  been  drawn  into  a  region  to  which  we  have 
dedicated  a  special  chapter,  that  of  suggestion,  or  auto- 
suggestion. The  examples  given  lead  us  to  anticipate  this 
investigation  and  to  say  that  feeling  alone,  affect  with  its 
well  known  sequelae,  and  not  some  other  particular  mechan- 
ism, fulfills  the  wish,  realizes  the  auto-suggestion. 


The  past  can  not  be  changed  ;  the  remembrance  of  it  is 
often  associated  with  very  lively  positive  or  negative  affects. 
There  are  people  who  live  on  the  remembrance  of  former 
happiness  and  are  thereby  happy.  Anger  due  to  injustice, 
remorse  on  account  of  wrong  one  had  done,  pain  due  to 
some  loss,  may  embitter  life  for  many  years  and  outweigh 
actual  sorrows. 

The  means  by  which  we  seek  to  preserve  the  pleasant 
feelings  of  the  past  have  been  as  yet  little  studied,  even 
though  mcminisse  juvabit  expresses  an  old  truth.  The 
past  seems  to  be  most  easily  revived  by.  so  arranging- 
external  conditions  that  memory  is  kept  awake,  and  all 
other  impressions  are  avoided.  Some  persons  who  have 
lost  some  one  dear  to  them  do  this  by  leaving  the  rooms 
and  everything  in  them  undisturbed  in  order  that  the  past 
may  continue  to  live  in  the  memory.  For  the  same  reason 
we  revisit  the  scenes  of  former  happiness  to  revive  the  old 
feelings  in  spite  of  changed  conditions.  There  may  be 
other  methods  of  a  more  psychological  nature,  but  as  yet  we 
do  not  know  them. 

Thanks  to  the  investigations  of  Freud  we  have  learned  a 
number  of  mechanisms  which  enable  us  to  make  painful 
feelings  associated  with  past  experiences  as  innocuous  as 
possible.  These  mechanisms  play  an  unexpectedly  im- 
portant role  in  hysteria,  the  obsessions,  dementia  praecox^ 
and  probably  other  disorders. 


18 

It  is  shown  most  clearly  in  pathological  cases  that  affec- 
tivity,  as  opposed  to  cognitive  processes,  has  a  certain 
independence,  that  affects  may  separate  themselves  from 
some  intellectual  processes  and  connect  themselves  with 
others.  It  is  well  known  that  they  may  spread,  and  that 
they  nia\^  invade,  as  far  as  time  and  content  are  concerned, 
other  mental  experiences  associated  with  a  decided  feeling- 
tone.  Thus  a  disagreeable  but  transitory  morning  experi- 
ence may  spoil  the  mood  of  the  whole  day;  the  erotic 
affect  which  originally  concerns  only  the  loved  one  may  be 
carried  over  to  the  rosette  which  she  wears  upon  her 
breast,  etc. 

Affectivity  moreover  shows  its  independence  in  regard  to 
the  intellectual  processes  in  another  way,  for  the  same  per- 
ceptions, the  same  experiences,  can  alter  according  to  the 
intellectual,  affective,  even  according  to  our  bodily,  disposi- 
tion. To  the  one  who  has  just  eaten,  a  meal  tastes  less 
pleasing  than  it  does  to  a  hungr5r  man;  when  we  are  in  an 
irritable  mood  the  music  which  we  hear  with  pleasure 
under  other  circumstances  annoj's  us  ;  when  we  are  tired  a 
lively  play  of  colors  which  would  be  otherwise  very  agree- 
able, awakens  in  us  a  feeling  of  displeasure. 

To  be  sure  there  may  be  another  explanation  for  this. 
The  idea  of  a  meal  does  not  stand  alone  in  our  mind.  The 
content  of  consciousness  consists  rather  of  a  mass  of  indi- 
vidual factors,  among  which  the  condition  of  satiety  or  of 
non-satiety  is  also  an  important  one.  Therefore  the 
mental  content  is  not  the  same  when  we  eat  in  a  hungry 
state  as  when  we  eat  already  satiated.  It  is  not  at  all  un- 
likely  that  the  emotio?ial  reaction  is  produced  not  only  by  the 
sight  and  taste  of  the  food,  but  that  it  corresponds  to  the  entire 
mental  content  at  the  time.  If  this  hypothesis  is  correct  it  is 
easily  understood  that  the  same  affect  can  not  always 
correspond  to  the  same  individual  partial  sensations  ;  be- 
cause the  affect  corresponds  in  reality  only  to  the  whole 
mental  content.  Hence  we  need  not  assume  that  our  enjoy- 
ment of  a  beautiful  painting  is  ' '  impaired  ' '  by  disagreeable 
surroundings.  In  our  mind  the  view  of  the  picture  and  the 
environment  are  a  whole  with  which  the  affect  of  pleasure  is 


19 

Tiot  associated.  The  pleasure  of  hearing  a  piece  of  music 
is  then  not  an  affect  related  to  the  music,  but  an  affect 
called  forth  by  the  music  in  association  with  our  psychic 
and  nervous  disposition.  We  would  react  emotionally  to 
the  piece  of  music  alone  as  little  as  we  would  under  ordin- 
ary circumstances  to  the  sight  of  a  knife.  But  if  the  knife 
is  in  the  hand  of  a  suspicious  looking  individual  whom  we 
meet  in  a  lonely  wood  the  liveliest  fright  can  be  provoked. 

A  sure  indication  of  the  independence  of  affectivity  is  the 
great  variation  in  emotional  reactions  in  different  individu- 
als to  the  same  intellectual  processes.  The  variation  is  so 
great  that  we  really  have  no  means  of  determining  what  is 
normal  and  what  pathological.  According  to  the  ruling  of 
German  courts  complete  defect  of  moral  feeling  (i.  e.,  the 
absence  of  an  emotional  tone  which  would  normally  be 
associated  with  moral  concepts)  does  not  count  as  patholog- 
ical unless  it  is  accompanied  by  intellectual  abnormalities. 

It  is  quite  different  with  the  intellectual  processes  among 
which  we  must  reckon  the  "intellectual  feelings"  as 
already  defined  in  this  chapter.  They  are  indeed  somewhat 
more  variable,  because  more  subjective,  than  the  primary 
intellectual  processes,  sensation,  perception,  etc.,  but  they 
may  be  compared  to  the  logical  faculties  which  also  show 
individual  differences.  Our  perceptions  present  within 
normal  limits  only  very  narrow  variations,  our  logical 
reactions  slightly  greater  ones  ;  and  where  these  functions 
are  but  little  defective  the  abnormal  condition  is  at  once 
perceived  by  the  laity.  When  we  have  parafunctions  of 
these  processes  (hallucinations  and  delusions)  the}r  are, 
even  when  mild,  quickly  noticed  as  pathological,  while  as 
regards  affectivity  it  is  impossible  in  many  instances  to 
distinguish  between  paraf unction  and  normal  function, 
since  the  same  object  may  liberate  in  the  one  esthetic  feel- 
ings of  a  positive,  in  another  of  a  negative  character. 

Moreover  there  is  also  very  little  relation  between  the 
distinctness  of  emotions  and  the  distinctness  of  intellectual 
processes.  Indeed  unclear  processes  (e.  g.  intellectual  feel- 
ings) are  very  often  accompanied  b}^  especially  lively 
affects. 


20 

The  development  of  the  intelligence  furthermore  is 
related  in  no  single  direction  to  the  development  of  affec- 
tivity.  Affectivity  is  fully  developed  in  the  young  child; 
all  the  emotions  of  adult  life,  even  the  most  complicated, 
are  already  present.  The  intelligence  of  a  child  on  the 
contrary  has  no  content  and  the  logical  processes  are  rela- 
tively feeble.  One  who  remains  intellectually  at  the  level 
of  development  of  a  child  is  an  idiot.  But  one  who  has  the 
affectivity  of  a  child  is  not  less  well  endowed  with  feelings 
than  the  normal  man.  The  difference  is  that  the  feelings 
in  the  latter  are  not  limited  by  the  intelligence. 

Moreover  in  adults  the  liveliest  feelings,  in  the  esthetic 
sphere,  for  example,  may  be  united  with  the  greatest  stupid- 
ity, and  inversely  supra-normal  intelligence  may  be  associ- 
ated with  defect  of  these  feelings.  Morality,  that  is,  the 
affective  tone  of  moral  concepts,  is  likewise  wholly  independ- 
ent of  the  development  of  moral  concepts  themselves.  Indeed 
a  certain  intuitive  morality  ( love,  capability  of  self-sacrifice, 
etc.),  is  often  present  in  the  lowest  idiots  while  the  corre- 
sponding concepts  are  nearly  or  wholly  lacking.  These 
cases  should  be  contrasted  with  moral  idiocy,  and  may 
make  it  clear  to  those  psychologists  who,  in  spite  of  the  fact 
that  an  independence  of  affectivity  and  intelligence  is 
accepted  in  other  spheres,  are  surprised  that  there  is  such 
a  thing  as  moral  idiocv. 


The  independence  of  affectivity  reaches  so  far  that  affects,, 
and  especially  moods  without  intellectual  substrata,  may 
develop  directly  from  bodily  feelings  or  physical  conditions. 
Disease  of  the  stomach  may  cause  ill-humor;  valvular 
heart  disease  anxiety;  and  tuberculosis  of  the  lungs 
euphoria  (just  as  euphoria  is  produced  by  health  of  all  the 
organs).  The  nerve-poisons,  especially  alcohol,  are  used 
because  of  their  definite  actions  on  affectivity. 

As  affectivity  allows  greater  space  for  individual  varia- 
tions than  do  the  intellectual  functions,  so  also  is  the  defense 


21 

against  unpleasant  feelings  very  different  in  different 
persons  and  circumstances.  We  shall  certainly  come  some 
day  to  the  classification  of  a  number  of  types  which  shall 
represent  more  distinctly  what  was  sought  to  be  expressed 
by  the  old  classification  of  temperaments.  For  the  present 
I  can  only  allude  to  what  I  mean. 

Many  individuals  who  resemble  somewhat  the  classical 
sanguine  type,  react  quickly  and  intensely  to  emotional 
impressions,  but  the  affect  rapidly  passes  away.  When  the 
storm  is  over  they  are  the  same  as  before.  It  is  as  if  they 
exhausted  the  affect  by  their  outward  reactions,  by  the 
hurrahing,  weeping,  scolding,  or  striking  blows.  If  the 
affect  be  repressed  against  the  natural  disposition,  it  is 
likely  to  lead  under  conditions  which  as  yet  are  not  well 
defined  to  shuntings  and  conversions  in  the  sense  of  Freud's 
pathological  reaction.  Subsequent  "unburdening"  (Abre- 
agieren)  may  then  under  certain  circumstances  cure  the 
morbid  symptom  or  symptoms  which  have  been  caused  by  a 
"'converted"  affect.  Women  and  children  seem  to  exhibit 
this  type  more  frequently  than  men. 

Another  group  of  individuals,  of  easily  excitable  nature, 
do  not  take  a  strong  disagreeable  affect  into  their  whole 
personality.  They  dissociate  the  affect  together  with  a 
large  complex  from  their  personality.  They  are  entirely 
normal  when  they  think  of  things  having  nothing  to  do  with 
the  affect  and  its  associated  intellectual  processes.  The 
affect  does  not  exist  for  them  nor  are  the  related  ideational 
processes  associated.  A  love  affair,  which  has  turned  out 
badly,  together  with  all  the  associations  of  the  Ego-complex 
•concerned  with  it  may,  so  to  speak,  be  cut  out  of  the 
person.  The  affect  is  revealed  chiefly  in  unconscious  acts 
which  betray  a  connection  with  the  experiences  of  the 
love  affair.  A  patient  whose  lover  had  shot  himself  forgot 
the  occurrence,  but  in  a  casual  conversation  pressed  rose 
leaves  to  her  temple  with  a  little  snap,  quite  unconsciously. 
This  could  be  demonstrated  to  be  what  Freud  calls  a  symp- 
tomatic act  ( Symptom- handlung) .  If,  however,  the  affair  or 
anything  associated  with  it  be  mentioned,  the  affect  is  im- 
mediately revived  and  with  it  the  remembrance  of  the  whole 
:  story. 


22 

It  is  evident  that  these  types  when  pronounced  are  pre- 
disposed to  hysterical  deliria,  since  the  dissociated  affective 
personality  often  possesses  too  few  associations  related  to 
actuality,  and  transforms  the  actual  experiences  in  accord 
with  the  affective  idea-complex. 

In  a  third  type  the  affects  develop  slowly.  They  re- 
quire a  longer  time  to  reach  their  maximum,  but  then 
remain  long"  active.  Lively  expressions  of  feeling  occur 
less  often  ;  the  affect  is  repressed.  Such  individuals  protect 
themselves  from  the  influence  of  disagreeable  affects  by  not 
thinking  of  the  experience,  which  can  only  be  successful 
by  avoiding  also,  as  far  as  possible,  the  associations  related 
to  the  unpleasant  occurrence.  Thoughts  and  occupations- 
are  so  arranged  that,  as  far  as  possible,  the  disagreeable 
occurrences  are  not  recollected  and  that  undesirable  mem- 
ories shall  be  fleeting  and  not  remain  to  be  pondered  over ;. 
consequent^  they  have  no  time  to  revive  the  more  slowly 
moving  affect.  Hence  the  affect  is  suppressed  though  it 
still  remains,  despite  this,  always  read}7  and  capable  of 
association.  The  unpleasant  experiences  are  likewise 
every  moment  accessible  to  memory.  Remembrance  is 
simply  avoided,  but  is  always  possible  at  an}'  instant.  The 
intellectual  feeling  that  certain  thoughts  must  always  be 
avoided,  a  sort  of  heaviness  of  heart,  which  gradually 
diminishes,  proves  the  persistence  of  the  repressed  affect.  If 
it  again  becomes  actual  through  remembrance,  it  dominates 
the  whole  personality  as  at  the  time  when  it  was  new. 

A  temporary,  complete  dissociation  is  also  possible  in 
this  type.  An  unpleasant  experience  that  can  not  at  the 
moment  be  gotten  square  with  because  of  other  duties, 
and  consequently  can  not  be  disposed  of,  is  dissociated, 
completely  forgotten.  While  the  other  occupations  continue, 
neither  the  feelings  nor  the  occurrence  exist  in  the  conscious- 
ness ;  it  is  only  later  that  it  re-emerges  and  has  to  be  elabo- 
rated and  disposed  of. 

If  suppression  of  the  affect  is  wholly  successful,  so  that  it 
exists  no  longer  for  consciousness,  it  is  often  '  converted"  ;. 
instead  of  the  affect,  some  physical  symptom  appears,  a  pain, 
an  hallucination.     A  patient  described  by  Riklin*  had  ear- 

*Psy chia trisch-neurotogische  Wochenschrift ',  igo^-iqoj. 


23 

ache  whenever  she  put  on  a  certain  jacket,  a  jacket  which 
she  had  worn  one  winter  day  in  the  woods  when  she  had 
given  birth  to  an  illegitimate  child  and  at  that  time  had 
contracted  earache.  The  connection  was  completely  un- 
known to  her,  the  jacket  reminding  her  neither  of  the  birth 
nor  of  the  affect. 

In  dementia  praecox  affective  experiences  are  transformed 
into  hallucinations,  delusions,  stereotypies,  all  generally 
having  some  obscure  symbolism,  while  the  original  affect 
can  not  be  demonstrated  or  is  rudimentary  (vide  the  works 
of  Jung  and  Riklin.  Journal  fur  Psycho  logie  zmd  Neurologic, 
1904,  also  Jung,  Dementia  prce  cox;  Halle,  Mar  ho  Id,  1906). 

There  are  doubtless  many  such  mechanisms  by  which 
disagreeable  affects  are  gotten  rid  of.  A  knowledge  of 
them  will  make  the  symptomatology  of  the  abnormal  as 
well  as  of  the  normal  mind  more  comprehensible,  and  at 
the  same  time  will  afford  us  some  help  for  treatment. 

Among  the  emotional  experiences  which  give  rise  to  the 
phenomena  we  have  described,  sexual  matters  play  a  very 
important  part,  though  perhaps  they  do  not  so  completely 
dominate  the  symtomatology  as  one  might  believe  from 
reading  Freud's  works.  There  are  important  reasons  why 
.  women  are  more  influenced  thereby  than  men,  aside  from 
the  stronger  sexuality  of  women,  which,  however,  has  been 
unduly  emphasized.  In  the  average  woman  her  whole 
career  depends  on  the  sexuality.  Her  instinct  of  self- 
preservation  makes  use  of  the  sexual  instinct.  To  her, 
marriage  means  that  which  to  a  man  means  success  in  busi- 
ness, ambition  in  all  directions,  a  well-conducted  struggle 
for  existence,  enjoyment  of  life,  in  addition  to  sexual 
pleasures  and  the  joy  in  children.  That  which  to  the  average 
man  appears  to  be  relatively  or  absolutely  unimportant, 
not  to  marry  or  illegitimate  sexual  indulgence,  has  for 
women  far-reaching  results  marked  by  the  strongest  affects. 
And  the  foolish  restrictions  of  our  culture  make  even  the 
thought  of  these  questions  impossible  to  a  well-bred  woman, 
requiring  not  only  the  suppression  of  all  acts  in  that 
direction  but  the  suppression  of  the  sexual  affect  itself.  It 
is  no  wonder  that  under  these  circumstances  one  meets  in 


24 

women  patients  at  every  turn  converted,  repressed,  dis- 
placed sexual  feelings,  those  feelings  which  make  up  at 
least  half  of  our  natural  existence.  I  say  at  least  half,  for 
the  analogous  instinct,  hunger,  seems  to  retreat  before  the 
sexual  and  this  is  true  not  in  the  case  of  civilized  man 
only,  for  whom  in  the  majority  of  instances  the  struggle  for 
food  is  either  unnecessary  or  comes  into  play  in  a  very 
indirect  manner.* 

One  of  the  most  important  manifestions  of  affectivity  is 
attention.^  We  are  attentive  to  processes  or  things  which 
interest  us.  Furthermore  we  can  force  the  attention  to 
turn  to  other  things,  but  we  always  have  an  affective  basis 
for  so  doing.  In  such  event  it  is  an  indirect  satisfaction  of 
an  interest,  as  when  I  read  a  tiresome  book,  which  it  is 
necessary  to  do  in  connection  with  my  work  which  interests 
me,  or  when  I  give  myself  up  to  a  psychological  experiment, 
the  results  of  which  are  to  satisfy  my  desire  for  knowledge  ; 
or  when  in  order  to  keep  away  discomfort  or  to  gain 
comforts  we  perform  tiresome  labors  for  food  or  money;  or 
when  one  works  to  avoid  punishments  as  in  the  case  of  a 
slave  or  a  convict. 

Therefore  a  personal  and  actual  interest  lies  at  the  basis 
of  passive  attention,  while  an  indirect  interest,  with  an 
affect  similar  to  that  of  fear  and  hope,  lies  at  the  basis  of 
active  attention.  Naturally  all  affects  which  are  not  here 
named  can  dominate  the  attention.  Those  cited  are  only 
those  which  are  most  frequent  in  daily  life.  Everything 
which  excites  an  affect,  anxiety,  fear,  joy,  love,  attracts 
our  attention  to  it.+ 

*  By  sexuality  is  understood  not  only  coitus  but  above  all  the  many  affects 
which  are  connected  with  sexuality.  These  latter  often  play  a  more  important 
part  with  women  than  sexuality  in  the  limited  sense.  I  know  a  woman  who 
was  very  neurasthenic  and  who  certainly  suffered  fro-.n  unsatisfied  desire  for 
love;  she  married,  became  markedly  better,  and  is  now  perfectly  happy,  although 
coitus  has  never  been  successful. 

+  Stransky  rightly  says  "  attention  =  interest,''  which  latter  corresponds  to 
feeling,  and  is  a  part  of  affectivity. 

%  There  are  whole  volumes  of  pedagogic  wisdom  in  the  simple  formula  :  The 
attention  of  a  child  can  be  turned  to  and  really  grasp  an  object  only  if  the 
teacher  can  bring  it  into  connection  with  some  idea  associated  with  a  strong 
affect. 


25 

What  we  know  of  attention  is  the  fact  that  it  causes  all 
these  perceptions,  associations,  and  movements  which  are 
related  to  an  object  of  interest  to  be  stimulated,  all  opposing 
ones  to  be  inhibited.  This  we  already  know  as  the  action 
of  affects.  When  I  turn  my  attention  to  the  problem  of 
attention,  all  the  associations  belonging  to  it  are  facilitated. 
Each  portion  of  the  problem  has  its  own  particular  interest. 
At  first  my  attention  was  turned  to  the  affects  which 
aroused  the  attention,  now  it  is  turned  to  the  associative 
changes  which  attention  creates.  All  these  particular 
associations  are  facilitated,  all  others  inhibited.  Without 
this  direction  of  the  thoughts  by  interest,  by  the  aim  of  my 
work,  I  could  just  as  well  have  passed  from  this  idea  of  the 
associations  to  the  work  of  Jung  and  Riklin,  then  to  that  of 
Aschaffenburg,  then  to  the  cathedral  at  Cologne,*  etc. 
These  last  ideas  would  never  have  appeared  in  conscious- 
ness while  writing  this,  if  I  had  not  needed  an  example  of 
the  kind  of  associations  which  are  ordinarily  inhibited 
under  these  circumstances.  I  have  here  made  such  a 
series  of  associations  for  the  first  time,  despite  the  fact  that 
I  have  been  occupied  with  the  problems  of  attention  and 
associations  for  years  past.  But  such  a  series  is  closely 
related  to  free  association,  also  to  "flight  of  ideas."  We 
come  now  to  that  which  Paulan  years  ago  designated  bjT 
the  name  of  ' '  loi  de  la  finalite  ' '  by  which  he  meant  that  the 
ordinary  laws  of  association  did  not  suffice  to  explain  the 
train  of  thought  if  the  purpose  or  ultimate  aim  of  the  train 
of  thought  were  not  also  reckoned  with  as  a  definite 
factor. 

For  us  it  suffices  to  know  that  attention  as  well  as  our 
whole  conduct  is  always  directed  by  affects;  or  better  ex- 
pressed: Attention  is  one  side  of  off ectivity  which  does  nothing 
else,  as  we  already  know,  but  facilitate  certain  associations  and 
inhibit  others. 

In  the  process  of  facilitation  we  naturally  have  to 
consider  not  only  the  intra-central  and  centripetal,  but  also 
a  mass  of  centrifugal  connections.  The  readiness  of  the 
senses,  the  adjustment  of  the  eye  for  example,  or  the  readi- 

*Prof.  Aschaffenburg  resides  in  Cologne. 


26 

ness  of  the  muscles  for  action  in  harmony  with  the  affects 
should  not  be  forgotten.  When  a  cat  fixes  its  attention  on 
a  mouse  hole  it  is  always  in  readiness  to  seize  the  pre}',  as  is 
shown  by  its  position  and  the  relative  tension  of  all  the 
muscles.  When  we  say  that  anxiety  makes  us  ready  for 
flight  or  defense,  it  is  the  same  as  saying  that  we  have 
turned  our  attention  to  the  object  of  anxiety  and  to  the 
accompanying  reactions.  The  well  known  theory  regard- 
ing the  origin  of  melancholic  delusions  can  be  described 
as  well  in  terms  of  the  affect  as  in  terms  of  attention:  it 
has  been  said  that  in  states  of  depression  only  depress- 
ive ideas  can  be  associated,  while  others  are  inhibited. 
One  might  equally  well  say  that  the  attention  being 
fixed  upon  sorrowful  ideas,  no  others  can  come  into 
consciousness.  The  process  is  the  same  as  when  an  investi- 
gator puts  forward  a  false  theory  and  then  spends  the  rest 
of  his  life  in  finding  support  for  it,  meanwhile  over-looking 
all  opposing  evidence.  His  attention  is  given  only  to  the 
former,  he  has  interest  only  in  observations  that  help  his 
cause. 

Attention  is  therefore  nothing  more  than  a  special  kind  of 
affective  action. 

As  the  forms  of  affectivity  change  so  do  those  of  atten- 
tion. In  the  organic  psychoses  the  affects  are  fleeting;  it  is 
the  same  with  attention.  The  manic  patient  colors  every- 
thing that  occurs  to  him  with  his  constantly  predominant 
positive  feeling-tone.  He  is  therefore  interested  in  every- 
thing, in  trivialities  as  well  as  in  the  important  things.     This 

leveling  of  ideas"  necessarily  causes  distractibility  by 
external  happenings.  A  further  consequence  is  the  flight 
of  ideas,  though  1  would  not  say  that  other  causes  may  not 
contribute  to  the  genesis  of  this  symptom.  In  dementia 
praecox  the  affects  are  more  or  less  repressed,  interest  is 
often  entirely  lacking,  and  attention  is  also  lacking.  The 
flow  of  ideas  is  without  direction.  The  ideas  are  connected 
with  an}-  given  idea  in  a  very  bizarre  manner  and  without 
selection. 

These  allusions  may  suffice  to  illustrate  the  meaning  of 
our  conception  for  psychopathology.      I  do  not  think  that 


Ave    express    views    with    which     all    our    colleagues    are 
familiar.  . 

More  popular  at  present  than  this  associative  conception  of  atten- 
tion is  a  dynamic  theory  which  sees  in  a  concentration  of  cerebral 
or  mental  forces,  or  even  in  a  greater  exertion  of  them,  the 
essential  nature  of  attention.  This  interpretation  often  starts  from 
the  feelings  of  fatigue.  At  present  we  can't  do  anything  with  the 
latter  in  a  psychological  analysis,  for  we  are  entirely  ignorant  of  their 
origin.  It  is  possible  that  even  in  purely  mental  exertion  of  the 
attention,  the  never-failing  tension  of  certain  muscle  groups  (eye 
muscles,  muscles  of  the  forehead)  plays  a  definite  role.  Again  on 
the  other  hand  we  know  that  the  feelings  of  physical  fatigue  may  be 
easily  dissipated  by  affects  and  other  influences  (Fere's  ivresse 
motrice) .  Therefore  we  can  not  make  use  of  fatigue  in  our  theoretical 
consideration.  On  the  other  hand  we  must  also  affirm  that  in  spite  of 
Fechner  we  have  no  means  of  measuring  the  intensity  of  mental 
processes.  All  that  we  know  at  present*about  them  is  reducible  to 
association  mechanisms.  Only  affectivity  and  its  expressions  appear 
to  us  to  have  intensity  and  are  matters  of  quantity.  But  while  we 
may  estimate  its  strength  we  can  not  measure  it  and  do  not  know  at 
all  upon  what  it  depends.  There  is  as  yet  therefore  no  possibility 
of  establishing  such  dynamic  theories  and  also  little  ground  for  seek- 
ing them.^  A  better  knowledge  of  the  physiological  basis  of  our 
mental  life  will  some  day  certainly  bring  the  dynamic  factor  into 
discussion. 

^  s£  ^  >i< 

According  to  many  writers  ''the  feelings  are  our  most 
individual  and  fundamental  possession  "  and  they,  not  the 
intellectual  presentations,  hold  the  Ego  together. t  This 
is  going  too  far.  To  our  Ego  belongs  all  that  we  experi- 
ence and  consciously  or  unconsciously  register,  including 
the  intellectual  as  well  as  the  affective  processes.  Among 
the  former  the  organic  feelings  are  held  with  a  certain 
amount  of  truth  to  be  pre-eminent  as  the  foundation  of  our 
Ego,  even  though  we  are  usually  not  conscious  of  them. 

In  this  connection  it  is  said  that  the   feelings   are  devel- 

*  How  premature  this  dynamic  theory  is,  is  plainly  seen  in  the  theories  which 
attempt  to  explain  the  differences  between  ideas  and  sensations  or  perceptions. 
Many  assume  tacitly  or  explicitly  a  greater  intensity  of  sensation  without  hav- 
ing a  shadow  of  proof.  To  be  consistent  we  would  then  also  have  to  assume 
that  hallucinations  differ  from  ideas  by  their  greater  intensity. 

^This  is  naturally  something  entirely  different  from  saying  that  our  char- 
acters and  our  actions  are  almost  exclusively  dominated  by  affectivity. 


28 

■oped  earlier  than  the  intelligence.  This  is  undoubtedly 
true  in  part,  but  I  believe  that  we  can  express  it  better  in 
another  way.  The  empty  intelligence,  the  capacity  of 
combining'  the  memory  pictures  of  our  experiences  so  as  to 
correspond  to  actual  experiences,  must  naturally  be  al- 
ready formed  at  birth,  for  the  acquisition  of  a  world-pic- 
ture depends  upon  the  analogy  associations  just  as  does  our 
logic.  What  the  child  lacks,  however,  is  experience.  It 
has  the  same  power  of  association  as  the  adult,  but  on  ac- 
count of  its  inadequate  experience  it  has  too  little  material 
for  association,  and  too  few  analogies  to  afford  direction  in 
any  given  case. 

Affectivity  needs  no  content,  no  material  from  without. 
Experience  only  furnishes  the  occasion  for  the  production 
of  an  affect.  Both  functions,  considered  in  the  abstract, 
are  therefore  developed  and  ready  at  birth.  But  intelli- 
gence in  order  to  express  itself  must  collect  material  through 
experience,  whereas  affectivity  needs  no  foreign  material  to 
immediately  express  itself  in  all  its  complications  and 
specializations  (the  sexual  sphere  naturally  excepted.)* 
What  we  ordinarily  call  highly  specialized  affectivity,  due  to 
high  development  of  character  and  to  education,  etc.,  is  the 
affective  side  of  a  highly  developed  and  complete  intelligence. 

Thus  we  see  in  children  the  most  complicated  emotional 
reactions,  already  present  at  a  time  when  the  content  of  the 
intelligence  is  ridiculously  insignificant.  Affectivity  directs 
the  associations  in  a  definite  manner  at  a  time  when  there 
is  no  chance  for  experience  to  enter.  We  see  this  in  the 
frequent  striking  intuitive  comprehensions  of  complicated 
situations,  and  the  yet  more  striking  correct  reactions  to 
them.  When  my  little  boy  of  five  months  first  stood  on  his 
own  feet  he  was  so  proud  of  it  and  started  around  so  like  a 
rooster  that  both  his  parents  burst  into  laughter.  But  this 
presently  caused  him  to  burst  out  crying  with  a  distinct 
attitude  of  annoyance.  He  could  not  endure  the  laughter 
at  his  new  accomplishment.  Any  one  who  was  not  present 
and  had  not  studied  the  whole  reaction  of  the  boy  before 
and  after  would  naturally  have  been  prone  to  believe,  as  I 

♦Even  that  perhaps  not  entirely.     Comp.  Freud  j  Abhandlungen  zur  Sexual 
Theorie,  Wieii,  Deuticke,  TQ05. 


29 

was  myself  at  first,  that  it  was  something  else  and  that  I  had 
imagined  the  pride  and  anger.  But  I  was  as  sceptical  as 
possible  in  this  matter,  and  daily  observation  of  the  child 
until  he  was  old  enough  to  express  himself  about  his  feel- 
ings admitted  of  no  other  conclusion.  Some  further 
examples  will  make  the  matter  clearer.  When  he  was 
eleven  months  old  he  desired  to  be  helped  up  one  day  as  he 
sat  on  the  floor.  I  refused,  with  the  remark  that  he  had  wet 
the  floor ;  then  he  assumed  a  determined  and  superior 
expression,  lifted  himself  slowly  from  the  floor  and  looked 
around  with  a  lordly  air  that  plainly  said  ' '  if  you  will  not 
help  me  I  know  how  to  help  nryself."  When  he  was  a 
little  more  than  a  year  old,  on  one  occasion,  he  would 
not  obey,  whereupon  I  said  to  him,  ' '  While  you  are  so 
little,  Papa  is  still  master."  Thereupon  the  little  fellow, 
who  could  scarcely  speak  a  half  dozen  words,  threw  his 
head  back  and  rocking  his  head  and  trunk  back  and  forth, 
as  if  he  were  going  to  bow  in  an  affected  manner,  he 
repeated  several  times  with  a  scornful,  ironical  mien  "Papa, 
Papa,  Papa."  This  was  done  in  a  mockingly  respectful 
tone  that  no  actor  could  have  surpassed,  just  as  if  he  wanted 
to  mock  me  as  a  boaster.  On  another  occasion  he  accident- 
ally said  "  Mamma  is  cross,"  and  as  soon  as  he  noticed  the 
mistake  he  reduced  it  ad  absurdum  by  designating  everyone 
present  as  cross,  including  himself.  When  he  was  thirty-one 
months  old  he  did  something  naught}'',  whereupon  I  told  him 
he  must  go  into  a  room  and  stay  alone  as  punishment. 
Without  reflexion  he  at  once  asked,  "is  pussy  there  too?" 
In  this  case  the  apparent  diplomacy  with  which  he  knew 
how  to  take  the  sting  out  of  the  punishment  was  astonishing. 
It  would  certainly  be  incorrect  to  seek  for  some  kind  of 
reasoning  or  intellectual  process  behind  this.  The  situa- 
tion brought  a  certain  defiance  into  action,  and  not  wish- 
ing to  offend  me,  the  affect  instinctively  brought  forward 
the  corresponding  reaction,  the  correct  association. 

Still  more  complicated  is  the  reaction  in  the  following- 
case,  which  has  been  described  to  me  by  a  competent 
observer.  The  little  one  was  about  two  years  old  when  a 
new  baby  sister  arrived.     The  bedding  was  displaced  on 


30 

one  occasion  by  the  convulsive  coughing  of  the  mother  who 
gave  her  husband  a  sign  without  speaking  of  the  accident 
because  she  knew  the  little  one  was  watching  her.  While 
the  father  set  the  things  in  order  again,  the  boy  turned  his 
back  to  the  bed  and  busied  himself  with  nothing,  exactly 
like  a  waiter  in  the  reception  room  for  travelers  who  has 
nothing  to  do  but  wait  for  orders  and  be  on  the  lookout. 
As  soon  as  the  clothing  was  put  to  rights  the  bo)r  again  re- 
gained his  natural  manner.  It  was  as  if  he  had  noticed 
nothing.  Some  days  later  he  received  a  reproof  from  his 
mother  because  he  had  wet  his  clothes.  The  answer  was 
"  Mamma  too — Mamma  too — Mamma  cough  too."  The 
latter  sentence  was  repeated  several  times  in  the  next  few 
minutes.  It  is  clear  that  the  child  at  once  apprehended 
through  his  feelings  and  not  by  means  of  conscious  intelli- 
gence, that  there  was  something  in  the  situation  to  be  con- 
cealed, something  that  it  would  be  well  not  to  notice  or  to 
appear  to  have  noticed.  He  reacted  to  this  situation  as  well 
as  an  intelligent  adult  with  conscious  reasoning  powers  could 
have  done.  But  he  had  also  understood  that  something  had 
occurred  similar  to  the  occasion  when  he  was  laid  in  a  dry 
bed,  and,  as  he  had  been  reproved,  he  could  not  repress  the 
excuse  that  his  mother  had  also  done  the  same  thing.  He 
dared  not  speak  directly  of  the  delicate  affair,  and  so  his 
instinct  used  a  substitution  and  named  the  coughing 
instead  of  the  disorder  in  bed  with  its  cause  and  accom- 
panying conditions — he  struck  at  the  sack  and  meant  the 
ass.  From  an  intellectual  standpoint  it  was  not  exactly 
wise,  for  he  told  his  secret  and  if  he  had  not  been  under- 
stood his  whole  defense  would  have  been  worthless.  But 
this  defect  proves  how  small  a  part  that  which  we  call 
intellect  played  in  the  matter. 

This  example  shows  very  well  what  kind  of  basis  our 
common  speech  has  when  it  talks  of  "  feeling  "  situations, 
in  an  attempt  at  expressing  the  fact  that  we  do  not  know  a 
thing  but  only  feel  it.  In  such  cases  it  is  the  affectivity 
that  guides  the  associations.  In  reality  it  is  not  a  question 
of  cognition  but  simply  of  an  instinctive  reaction  which 
hits  the  mark.     The  partly  external,  but  in  some  respects 


also  essential  resemblance  to  some  of  our  medical  diagnoses 
which  we  make  by  "feeling"  or  intuition,  as  it  were,  is 
obvious,  even  though  in  this  case  unconscious  observations 
and  conclusions  are  essential,  while  the  affectivitv  is  more  in 
the    backo-round. 


We  now  come  to  the  question  of  the  relation  of  instincts 
to  affects.  We  can  not  exhaust  the  subject  here  and  a  few 
references  must  suffice.  There  is  only  one  instinct  in  man 
that  is  in  some  degree  clearly  defined,  viz.  :  the  sexual 
instinct.  All  others  are  hidden  b}^  our  complicated  condi- 
tions. The  desire  for  food  impels  us  to  a  great  variety  of 
actions  which  accomplish  their  object  in  a  very  indirect 
way.  Even  the  thrashings  received  at  school  are  supposed 
to  be  useful  for  us  later  in  the  fight  for  existence.  Then 
we  do  not  directly  acquire  food  but  money  which  may  also 
be  used  for  other  objects.  Moreover,  we  may  live  without 
concerning  ourselves  with  our  instinct  for  getting  food. 
The  man  living  on  his  income,  as  well  as  the  tramp  in  the 
almhouse,  does  nothing  toward  obtaining  food,  and  the  in- 
sane are  often  fed  artificially  against  their  will,  etc.  The 
sexual  instinct,  however,  appears  to  be  still  fairly  primitive 
and  unchanged.  Here  we  see,  how,  through  pleasure  in  cer- 
tain actions,  we  are  voluntarily  or  involuntarily  driven  to  do 
that  which  insures  the  preservation  of  the  species.  In  this 
also  nature  acts  in  an  indirect  way.  All  kinds  of  flirting, 
the  choosing  of  a  cravat,  or  of  a  ball-dress,  all  conduce  to 
the  one  end,  even  though  Nature's  aim  therein  is  usually 
unknown  and  would  be  violently  denied.  The  essential 
feature  in  this  human  instinct  is  therefore  that  the  corre- 
lated actions  in  certain  sequences  and  under  certain  condi- 
tions are  associated  with  a  pleasant  emotional  tone  and  are 
hence  sought  after.  We  see  the  same  where  the  nutrition 
impulse  is  directly  satisfied  by  eating  and  drinking,  and  in 
the  case  of  the  mother  nursing  the  child.  The  eater 
and  the  nursing  mother  also  have  pleasure  in  the  act. 
We  may  suppose  that  the  same  conditions  exist  in  the 
simple  as  well  as  in  the  complicated  instincts  of  the  lower 


animals  ;  indeed  when  we  compare  the  emotional  expres- 
sions of  animals  with  onrs,  we  must  perforce  assume  the 
like  conditions.  The  building  of  a  nest,  for  example,  is 
doubtless  accompanied  by  an  agreeable  feeling  tone.  Nev- 
ertheless the  instincts  have  also  an  intellectual  component. 
It  does  not  suffice  that  certain  actions,  if  carried  out,  should 
appear  agreeable.  There  must  also  be  in  the  nervous  sys- 
tem an  impelling  force  to  perform  the  actions.  Otherwise 
we  should  only  accidentally  follow  an  instinct,  as  is  some- 
times the  case,  to  be   sure,  with  the  human  sexual  impulse. 


The  dominating  position  of  affectivity,  as  well  as  its 
marked  independence  of  intellectual  processes,  is  best  shown 
in  pathological  conditions .  It  seems  in  this  domain  to  be 
altogether  an  elementary  attribute  of  the  mind,  dominating 
the  whole  picture  of  the  disease,  altering  the  intellect  as  it 
may  require,  and  suffering  least  damage  in  the  pathological 
processes.  In  the  most  severe  brain  diseases  the  feelings  are 
not  destroyed  ;  on  the  contrary,  their  influence  upon  the 
damaged  intellectual  processes  is  stronger  than  under 
normal  conditions. 

To  be  sure  the  opposite  is  stated  in  most  text-books  of 
psychiatry.  Krsepelin,  for  example,  says  that  in  senile  de- 
mentia the  feelings  are  also  blunted,  that  the  patient 
becomes  apathetic  and  indifferent,  that  the  loss  of  near 
relatives  and  similar  occurrences  pass  over  him  without 
making  a  lasting  impression,  and  that  the  patient  becomes 
indifferent  to  his  family,  his  profession,  and  his  favorite 
avocation. 

This  interpretation  seems  to  me  to  be  incorrect,  accurate 
as  are  the  observations.  What  we  are  dealing  with  is  a 
secondary  disturbance  of  affectivity.  Affectivity  as  such 
is  preserved.  As  soon  as  we  succeed  in  making  the  ideas 
mentioned  above  sufficiently  clear  to  a  patient  with  organic 
brain  disease,  we  see  the  feelings  reappear,  and  the  reactions 
correspond  qualitatively  to  those  of  a  normal  person. 
Whenever  it  is  possible  for  the  patient  to  conceive  in  some 
measure  the  relation    of   his  profession    or   of   his    family 


33 

to  himself  the  emotional  reaction  never  fails  to  appear. 
If  he  compares  the  present  with  the  past  he  will  generally 
moan  and  weep.  If  his  earlier  accomplishments,  or  the 
good  circumstances  of  his  family  come  to  the  foreground, 
we  note  feelings  of  pride  and  contentment.  It  is  the  same 
with  the  moral  depravity  of  the  senile  or  general  paralytic. 
It  is  not  based  upon  anomaly  of  the  feelings.  These  patients 
indeed  commit  all  sorts  of  offences  against  propriety  and 
property .  The  defect,  however,  lies  in  the  intellectual  sphere, 
and  where  the  feelings  come  into  play  their  influence  on 
the  flow  of  thought  is  even  greater  than  in  the  normal,  and 
there  is  no  lack  of  emotional  reaction.  Take  for  example 
an  old  man  who  has  violated  children.  Ordinarily  he 
speaks  of  his  offence  with  indifference  and  seems  to  be 
blunted  in  his  moral  sense.  But  the  fact  is  that  the  com- 
prehension or  the  conception  of  the  criminality  of  his  deed 
is  wanting.  Of  course  the  actual  remembrance  of  the 
occurrence  is  not  apt  to  be  absent,  but  in  this  thought 
alone  there  is  no  basis  for  a  negative  emotional  tone.  When 
an  oriental  marries  an  immature  maiden  and  has  intercourse 
with  her  he  has  no  scruples  and  indeed  can  not  understand 
why  such  should  exist.  In  such  matters  the  relation  of  the 
deed  to  all  our  social  and  sexual  ideas  and  customs  must  be 
taken  into  consideration.  Only  a  more  or  less  conscious 
presentation  of  these  numerous  associations  can  give  rise  to 
a  negative  feeling  tone  (abhorrence  for  the  act  or  remorse), 
if  the  sexual  feelings  as  such  can  be  aroused  as  well  by  a 
child  as  by  a  mature  woman.  That  the  difference  between 
a  child  and  a  woman  is  not  always  made  by  those  suffering 
from  an  organic  psychosis  must,  after  all,  be  due  to  a 
disturbance  of  the  associations,  a  disorder  of  the  concept  in 
its  widest  sense,  whereby  only  one  characteristic  of  the 
person  is  recognized,  the  femininity  and  not  the  youth. 

Now  if  we  succeed  in  making  clear  to  the  seemingly 
indifferent  patient  the  real  nature  of  his  offense,  with  its  sig- 
nificance to  society  and  to  his  unfortunate  victim,  the  feel- 
ings of  abhorrence  and  remorse  arise  in  him  as  they  would 
have  done  when  he  was  in  a  normal  condition.  The  ex- 
periment can  naturally  not  be  made  in  all  cases ;  but  it  is 


34 

generally  possible  to  obtain  from  such  patients  affective 
reactions  to  the  simpler  ethical  ideas,  and  to  do  this  it  is  only 
necessary  to  bring  before  the  patient  the  particular  idea 
concerned,  together  with  all  its  necessary  components.  For 
example,  the  affection  for  the  family,  which  may  apparently 
be  wholly  lacking,  may  often  be  well  demonstrated  before 
a  large  audience  of  students.* 

What  is  pathological  in  the  organic  psychoses,  so  far  as 
the  feelings  are  concerned,  is  that  they  dominate  the  thoughts 
more  strongly  than  in  healthy  individuals.  Their  inhibitory 
and  helping  influence  on  associations  is  rendered  stronger 
by  the  faultiness  of  intellectual  function.  In  other  words, 
the  senile  or  general  paralytic  can  ordinarily  think  of  that 
only  which  is  correlated  with  his  affect,  with  his  impulse. 
When  his  sexuality  is  aroused,  he  sees  in  the  little  girl  only 
the  female  that  can  satisfy  his  desire.  Opposing  associa- 
tions often  fail  completely,  or  are  limited  to  the  taking 
of  a  few  foolish  precautionary  measures.  When  a 
general  paralytic  hangs  around  some  object  on  the  ward 
which  seems  to  him  desirable,  and  then  suddenly  hides  it 
under  his  clothes  in  the  sight  of  a  dozen  witnesses,  he  gives 
no  thought  to  the  witnesses,  and  quite  as  little  to  the  moral 
depravity  of  the  theft.  He  wanted  one  thing,  and  therefore 
he  took  it.  But  under  other  circumstances  he  may  detest 
a  theft,  namely,  when  he  can  represent  to  himself  the  crime 
as  such.  The  general  paralytic  of  Kraepelin  who  jumped 
from  a  third  story  window  to  get  a  cigar  stump,  thought 
only  of  gaining  the  valuable  object,  but  not  of  the  danger, 
of  the  height  of  the  fall,  etc. 

One  sees  the  same  thing  in  simple  association  experi- 
ments; the  associations  of  such  patients  are  dominated  by 
affects  to  a  greater  degree  than  under  normal  conditions. 

Another  pathological  manifestation  of  affectivity  in  pa- 
tients with  organic  brain  disease  is  its  diminished  durability. 
We  are  wont  to  speak  of  the  "superficiality  of  their 
feelings."  They  may  change  from  one  moment  to  another 
if  a  variety  of  different  ideas  can  be  brought  before  them. 

*Of  course  we  must  exclude  complications  such  as  mild  stuporous  conditions 
which  are  not  infrequent  in  organic  psychoses,  also  cerebral  pressure  from 
light  apoplexies,  etc. 


35 

It  is  frequently  possible  to  get  a  paralytic  to  laugh,  cry,  and 
laugh  again  in  the  same  minute.  Such  patients  come  to 
appear  childish,  and  indeed  we  speak  of  second  childhood 
in  the  aged. 

Therefore  affcctivity  as  such  is  retained  in  the  organic  psy- 
choses. The  reactions  of  the  emotions  are  proportionate  to  the 
intellectual  reactions.  On  the  other  hand  they  are  excited  too 
easily  a?id  have  little  persistence.  The  blunting  of  the  feelings 
is  secondary  and  rests  on  the  fact  that  concepts  can  not  be 
perfectly  apprehended,  so  that  no  corresponding  emotional  re- 
action can  be  aroused.  Moreover  the  affectivity  dominates  the 
associations  much  more  than  in  normal  individuals . 

Similar  conditions  are  found  in  alcoholism.  It  is  on  the 
whole  incorrect  to  say  that  the  feelings  of  the  chronic  alco- 
holic are  dulled.  He  is  on  the  contrary  ruled  by  his 
affectivity.  When  he  treats  his  family  badly,  and  neglects 
his  business,  there  is  always  a  positive  cause  for  it.  He  has 
other  interests  which  so  occupy  him,  and  whose  accompany- 
ing affects  so  dominate  him,  that  he  forgets  every  other 
consideration.  In  his  outbursts  of  affection,  in  his  moments 
of  repentance,  every  ordinary  alcoholic  shows  hundreds  of 
times  that  he  still  has  feelings  for  his  family.  If  he  is  con- 
fined in  an  asylum  he  may  write  his  ill-treated  wife  the 
most  beautiful  heartfelt  letters,  and  shower  her  with  words 
of  affection.  This  makes  the  alcoholic  so  dangerous.  With 
real  conviction  and  actual  emotion  he  will  make  the  most 
beautiful  promises,  will  manifest  the  greatest  affection,  so 
that  as  a  rule  the  wife  who  has  been  deceived  a  hundred 
times  allows  herself  to  be  deceived  the  hundred  and  first. 
The  alcoholic  will  coram  publico  break  into  floods  of  tears 
when  frost  threatens  the  crop  of  a  neighbor,  while  at  the 
same  time  he  allows  his  own  property  to  go  to  ruin,  and  mal- 
treats his  wife  and  children.  In  company,  where  only 
words  and  feelings  and  not  deeds  are  required  of  him,  he 
may  rightly  pass  for  a  man  of  good  instincts  and  beautiful 
enthusiasm,  no  matter  how  meanly  he  may  conduct  himself 
at  home  with  his  family.  There  is  no  dulling  of  the  feel- 
ings in  him,  but  they  are  too  easily  excited  and  too  fleeting. 
There  are  lacking  in   him  perseverance,  and  the  power  to 


36 

resist  temptation.  Temptation  overcomes  him  in  the  same- 
way  that  a  moment  before  another  feeling  had  dominated 
him.  That  so  little  good  and  so  much  bad  is  produced  by 
these  changeable  feelings  is  easily  explained  by  the  fact 
that  to  accomplish  anything  good  requires  persistence  and 
perseverance,  whereas  a  foolish  or  a  mean  thing  may  be 
done  quickly.  We  do  not  see  anything  strikingly  good  in 
it  when  a  drinker  on  his  return  home  in  a  more  or  less 
cheerful  mood  is  affectionate  to  his  wife,  but  we  naturally 
consider  his  actions  in  every  way  reprehensible  if  a  moment 
later,  excited  by  some  repugnance  on  her  part,  he  is  brutal 
to  her.  Unfortunately  he  may  be  credited  with  virtue  by 
casual  hearers  if,  at  some  patriotic  banquet  he  delivers  a 
deeply-felt  address,  which  however  he  is  wholfy  unable  to 
live  up  to.  The  affectivity  of  the  alcoholic  is  not  reduced,  but 
increased;  all  the  emotions  ca?i  be  aroused  in  him  and  more 
easily  than  in  a  normal  individual,  but  they  lack  durability. 
The  alcoholic  suffers,  as  do  the  organic  cases,  only  from 
"  emotional  incontinence." 

A  certain  contrast  to  this  is  afforded  by  the  affectivity  of 
the  epileptic.  Here  also,  in  spite  of  their  notorious  egoism, 
no  affect  is  wanting  which  belongs  to  the  normal  individual. 
So  far  as  there  is  actual  limitation  of  affects,  it  is  due  to 
limitation  of  the  associations.  The  affects  are,  moreover, 
easily  called  forth,  but  they  have  a  certain  persistence, 
although  this  is  not  the  persistence  needed  for  productive 
occupation,  but  a  persistence  which  does  not  let  the  affect 
subside  in  a  natural  way  (anger  or  rage,  for  example). 
The  affects  of  the  epileptic  are  not  labile  in  the  sense  that 
they  may  rapidly  replace  one  another  as  in  organic  psychoses 
and  alcoholism.      The  perseveration  shows  itself  also  in  affects. 

In  idiocy  too  the  affects  are  not  really  defective.  At  any 
rate  they  are  possible  within  very  wide  limits.  Hyper- 
emotivity  and  apathy  occur  more  frequently  and  in  a  higher 
degree  than  in  normal  individuals,  but  this  is  not  more  pro- 
nounced than  in  intelligent  psychopaths.  And  I  am  not 
aware  of  any  positive  evidence  that  defects  of  individual 
emotions,  such  as  moral  feeling,  are  more  frequent  in  idiots 
and   imbeciles  than  in  intelligent  people.     But    naturally 


6/ 

idiots  can  form  no  emotions  in  connection  with  ideas  which 
they  do  not  have.  This  is  not  a  defect  of  the  feelings,  but 
an  intellectual  defect,  while  its  influence  on  the  feelings  is 
not  abnormal. 

Thus  we  see  affectivity  developed  and  persisting  even 
wThere  intelligence,  in  the  narrower  sense,  is  not  developed  or 
is    destroyed.       It   persists    as    long    as   the   most   simple 

objective  ' '  processes,  the  sensations  and  simple  cognitions; 
in  individual  cases  even  longer.  Cases  of  senile  dementia 
and  general  paralysis  still  have  decided  emotions  when 
perception  and  sensation  are  markedly  disordered. 

And  yet  there  is  a  disease  in  which  the  suppression  of  the 
-emotions  may  be  said  to  occupy  the  foreground  of  the  pic- 
ture, viz.  dementia praecox.  In  this  disorder  the  anatomical 
changes  in  the  brain  are  so  slight  that  it  has  not  yet  been 
possible  to  define  them.  The  intelligence  is  not  destroyed, 
but  only  suppressed,  as  is  evidenced  by  certain  temporary  or 
permanent  improvements  and  '  'late  recoveries. ' '  The  affect- 
ivity, however,  in  the  majority  of  cases,  is  hopelessly  defect- 
ive. It  is  not  conceivable  that  such  an  elementary  function 
can  be  simply  blotted  out  of  the  brain  by  a  minute  pathological 
process.  Therefore  the  question  is,  what  has  become  of  the 
affects  in  dementia  precox  f  The  question  is  answerable,  and 
I  hope  that  the  work  of  my  colleague  Jung*  will  in  the  near 
future  be  so  far  along  as  to  afford  us  at  least  a  glimpse  of  the 
mechanisms  which  remove  the  affects  from  our  observation. 

We  shall  deal  with  paranoia  only,  whose  genesis,  to  many 
alienists,  is  related  to  abnormal  affects,  and  we  shall  further 
on  devote  a  special  chapter  to  it. 

%.  ;|c  >i<  % 

What  affectivity  is  we  can  not  say.  But  for  our  purposes 
this  is  only  an  academical  question.  It  is  sufficient  for  us 
to  know  that  intellectual  processes,  psychopetal  and  intra- 
psychic association-complexes,  not  only  cause  the  special 
respective  reactions,  but  also  so  dominate  the  associations  of 
the  entire  nervous  system,  including  the  vasomotor  and 
splanchnic  nerves,  that  a  general  reaction  occurs  which 
-gives  support  to  the  special  reactions  and,   apart  from  ex- 

*Dementia  Praecox,  Halle,  Marhold,  1906. 


38 

ceptional  conditions  to  which  the  organism  is  not  adapted,, 
contributes  to  the  general  advance  of  the  individual. 

Nevertheless,  there  are  certain  questions  in  this  con- 
nection which  I  should  like  to  touch  upon  briefly.  Is 
feeling,  or  aff ectivity  in  our  sense  of  the  term,  a  property  of 
sen sory  perception  ?  (Ziehen).  Is  it  contained  in  sensory 
perception?  (Wundt).  Or  is  it  an  independent  parallel 
process  of  consciousness?  (Kuelpe). 

When  we  understand  clearly  that  the  centripetal  stimulus 
produces  both  the  sensory  perception  and  the  feeling,  but 
that  with  the  same  sensor}^  perception  the  feeling  may  vary, 
it  seems  as  if  everything  necessary  were  said;  the  ques- 
tion is  evidently  one  of  terms.  That  is  to  say,  it  depends 
on  whether  we  wish  to  include  the  accompanying  feeling  in 
the  concept  of  sensory  perception  or  not. 

I  would  much  rather  combine  affectivity  and  volition  into 
one  comprehensive  unity,  for  affectivity  is  much  more 
closely  connected  with  desires,  instincts,  and  will,  than  with 
intellectual  processes.  It  is  scarcely  possible  even  theoret- 
ically to  separate  the  two  psychic  functions  from  each  other; 
it  is  almost  as  if  affect  and  desire  were  one,  and  as  if  with 
these  words  we  had  only  theoretically  isolated  two  different 
sides  of  one  process.* 

Is  feeling  {affect)  the  sum  of  all  changes  produced  by  the 
intellectual  process  ?  (  Lange) . 

Possibly,  and  1  think  very  probably.  But  in  relation  to 
this  we  must  consider  not  only  the  physical  but  also  ihe 
psychical  symptoms,  the  inhibitions  and  facilitations. t 
At  any  rate  the  feeling  of  pleasure  and  displeasure  seems 
to  me  to  be  the  essential  feature  of  the  affects,  and  one  might 
put  the  question  thus:  Is  there  a  special  process  in  the  brain 
which  is  the  substratum  of  pleasure  and  displeasure,  or  do  the 
associative,  the  vasomotor  and  the  secretory  inhibitions  and 
facilitations  together  make  up  the  feeling  of  pleasure1?  This 
question  is  as  yet  not  answerable. 

*  I  can  not  believe  in  an  independent  will-function  nor  indeed  in  a  faculty  of 
volition  since  pathology  is  not  aware  of  simple  diseases  of  will. 

t  It  would  be  remarkable  if  the  latter  were  not  also  perceived.    It  is  certain 
from  Lehmann's  investigations  that  the  appreciable  physical  symptoms  of  the- 
affect  come  on  more  slowly  than  the  purely  psychical,  and  that  therefore  they 
can  not  be  essential. 


39 

For  the  time  being,  therefore,  it  seems  to  me  a  matter  of 
indifference  whether  we  say  ' '  an  intellectual  process  is  the 
cause  of  the  affect  "  or  "it  contains  it,"  just  as  it  may  be 
the  same  whether  we  say  ' '  an  affect  causes  symptoms  such 
as  palpitation  of  the  heart "  or  "  palpitation  of  the  heart  is 
a  component  of  an  affect  "  or  "an  affect  is  the  sum  total  of 
all  symptoms  ascribed  to  it." 

The  theories  that  various  cell-conditions  have  to  do  with 
the  feelings  of  pleasure  and  displeasure  (Meynert)  I  pass 
over  as  being  entirely  in  the  air.* 

Of  greater  interest  is  the  question  whether  the  various 
affects  are  differences  in  degree,  or  whether  they  are  quali- 
tatively different,  or,  otherwise  expressed,  whether  they  are 
of  one  or  many  dimensions.  If  they  were  due  to  differences 
in  degree  the  qualitative  difference  would  have  to  be  sought 
in  the  accompanying  intellectual  processes.  Unfortunately 
this  question  also  can  not  be  answered  with  certainty.  In- 
deed we  do  not  as  yet  know  whether  the  simple  feelings  of 
pleasure  and  displeasure  are  something  quite  different  from 
affects  in  a  narrower  sense  such  as  hate,  anger,  etc.  They 
might  perhaps  be  partial  manifestations  of  affects  which 
necesarily  accompany  them. 

To  me  the  feeling  caused  by  the  sight  of  a  beautiful  pic- 
ture and  that  caused  by  eating  a  good  beefsteak  seem  to  be 
very  different.  Others  have  tried  to  explain  complicated 
affects  as  mixed  conditions  of  pleasure  and  displeasure,  but  it 
does  not  seem  that  they  have  succeeded  in  proving  this  view. 

We  must  reject  the  conception  of  Wundt  that  affects  are 
three  dimensional.  "Feelings  of  tension  and  relaxation," 
and  "of  excitation  and  depression"  are  pre-eminently 
inner  cognitions,  not  feelings  in  our  sense.  Tension  and 
relaxation,  excitation  and  depression,  may  be  part  of  an 
affect,  and  their  cognition  may  be  associated  with  pleasant- 
ness and  unpleasantness,  as  are  other  intellectual  processes. 
If  there  be  anything  of  truth  in  this  dimensional  theory  it 
is  insufficiently  or  not  all  expressed  in  Wundt's  formulation. 

Lipp's  three  dimension  theory  seems  to  me  to  be  even 
less  well  founded. 

*  Naturally  we  can  also  do  nothing  with  the  view  of  Wernicke  that  the 
emotional  tone  of  sensory  perception  is  an  affection  of  the  somatopsyche. 
{Grundriss  der  Psvchiatrie:  p.  44.) 


40 


SUGGESTION. 


Suggestion  seems  in  certain  respects  to  resemble  the 
intellectual  feelings  of  Nahlowsky.  To  believe,  to  doubt, 
to  guess,  to  regard  as  certain,  to  convince  one's  self  on 
the  one  hand,  and  to  accept  a  suggestion  on  the  other 
hand,  all  these  express  in  the  same  sense  the  intellectual 
reaction  of  our  ego  to  some  idea.  And  yet  there  is  a  very 
important  difference  between  suggestion  and  the  other  pro- 
cesses cited.  Suggestion  goes  much  further.  To  believe, 
to  convince  one's  self,  and  all  these  reactions  are  not  able 
to  influence  bodily  functions,  to  produce  hallucinations,  or 
to  so  dominate  the  logic  that  the  grossest  nonsense  is 
accepted  against  all  evidence.  To  be  sure  the  supposition 
of  a  danger  may  produce  bodily  manifestations,  but  in  an 
indirect  way  through  the  anxiety  which  it  produces;  belief 
causes  constantly  the  acceptation  of  illogical  thoughts  and 
sometimes  the  appearance  of  hallucinations,  but  when  this 
is  the  case  an  affect  or  suggestion  also  play  a  part,  and  in- 
deed belief  is  scarcely  ever  free  from  the  action  of  sugges- 
tion (take  the  case  of  religion  and  politics).  In  such  cases 
therefore  the  results  which  go  beyond  the  intellectual  sphere 
are  not  direct  consequences  of  the  intellectual  feelings. 

Suggestion  however  produces  all  this  directly.  It  controls 
the  functions  of  the  glands,  of  the  heart,  of  the  vasomotor 
system,  of  the  intestines,  it  disassociates  certain  idea-complexes 
from  those  which  are  contradictory,  it  shuts  out  criticism, 
rules  the  senses  so  that  it  may  readily  create  illusions,  and  also 
positive  and  negative  hallucinations . 

As  we  have  seen,  exactly  the  same  result  may  be  brought 
about  by  the  affects.  The  objective  actions  of  suggestion 
are  therefore  the  same  as  those  of  the  affectivity,  but  dif- 
ferent from  those  of  the  intellectual  processes. 

The  kind  of  action,  as  far  as  we  know  anything  of  it,  is 
also  the  same.  We  know  that  the  affective  accompaniment 
of  a  thought  favors  the  associations  which  correspond  to  the 
affect  but  renders  others  more  difficult  or  inhibits  them.  In 
this  way  the  acceptance  of  a  thought  is  favored,  critical 
judgment  however  is  rendered  impossible,  exactly  the  same 
as  in  the  case  of  a  suggestive  idea. 


41 

If  we  seek  the  basis  of  suggestion  we  meet  similar  condi- 
tions; we  are  unable  to  explain  it  through  intellectual 
processes,  but  on  the  other  hand  we  note  the  close  relation- 
ship with  what  we  find  in  the  action  of  affects. 

Bernheim  however  derives  suggestion  from  credulity 
{c?'edivite)  which  every  one  possesses.  Very  likely  this  plays 
a  certain,  not  unimportant  role  in  intellectual  suggestions, 
particularly  those  communicated  by  speech,  which  are  the 
most  frequent  among  human  beings.  But  the  power  of 
suggestion  is  not  to  be  explained  on  this  basis.* 

Let  us  take  an  ordinary  case.  A  mother  tells  her  child 
that  "the  porridge  is  hot";  the  child  has  already  gained  an 
idea  of  ' '  hot, ' '  but  in  spite  of  the  warning  he  tries  to  eat 
the  porridge  and  burns  his  mouth.  In  a  million  cases  that 
which  is  said  to  him  will  be  verified  by  his  own  experience. 
The  child  must  therefore  by  analogy  learn  to  regard  what 
his  parents,  his  teacher,  tell  him  as,  in  the  main,  correct  even 
when  individual  experiences  are  lacking.  This  kind  of 
belief  or  credulity  is  a  peculiarity  of  all  men  and  is  a  con- 
ditio sine  qua  non    for  any  educability. 

If  one  regards  only  the  intellectual  processes,  such  an 
action  of  credulity  may  be  conceived  as  a  suggestion: 
one  accepts  something  as  the  truth  without  proof  or 
examination  simply  on  the  assurance  of  some  other 
person . 

*  We  will  omit  a  criticism  of  the  numerous  theories  and  explanations  of  sug- 
gestion, but  refer  only  to  one  of  the  newest,  that  of  Stern.  According  to  Stern 
(Psychologie  der  Aussage,  1,  336)  (passive)  suggestion  is  a  simple  mental  attitude 
(Stellungnahme).  This  conception  is  insufficient  because  the  same  maybe  said  of 
.an  ordinary  belief.  If  I,  with  Stern,  say,  "here  is  a  table"  and  the  hearer  believes 
that  a  table  stands  here  although  in  reality  none  does,  this  is  not  yet  sugges- 
tion; if  the  possibility  of  control  is  excluded  it  is  simply  a  question  of  belief- 
If  the  hearer  can  see  the  place  where  the  suggested  table  should  stand  then  he 
must  either  reject  the  suggestion  or  hallucinate  a  table.  The  belief  in  these 
cases  is  entirely  a  subordinate  matter,  the  essential  thing  is  the  hallucination,  a 
much  more  profound  interference.  Again,  if  Stern  designates  suggestion  as  an 
■"  imitation  of  mental  attitude  "  (Stellimgnalime),  he  includes  too  much  in  the 
idea;  for  all  belief  is  such  an  imitation.  Nevertheless  it  is  interesting  that 
Stern  with  the  idea  of  imitation  or  as  he  has  more  accurately  expressed  it  with 
the  "assumption  of  the  mental  attitude  of  another  with  the  appearance  of  our 
own  attitude  "  comes  very  near  our  own  conception.  Quite  useless  are  such 
theories  as  that  of  Lipps,  (Zeitsclirift  fur  Hypnotismus,  jSqy  p.  94  ,ff)  which 
takes  only  the  extremes  into  consideration,  or  the  similar  one  of  Hellpach 
(Psychologie  der  Hysterie,  p.  sod)  which  assumes  as  the  criterion  of  all  psychical 
consequences,  which  can  be  called  suggestion,  their  senselessness  and  ex- 
aggerated character. 


42 

I  would  prefer  not  to  extend  the  conception  of  suggestion 
so  far. 

When  the  parents  in  the  same  tone  say  something  to  the 
child  that  his  perceptions  or  (later)  his  logical  under- 
standing contradicts,  it  is  no  longer  believed;  perception 
and  logic  hold  their  own  in  spite  of  the  assertion.  Just  as 
little  can  simple  credulity  influence  the  movements  of  the 
heart  or  intestines  or  the  glandular  secretion;  or,  in  the 
psychical  sphere,  dissociate  a  part  of  the  personality  and 
make  it  independent,  as  it  were.  The  influence  of  credulity 
is  therefore  not  so  far-reaching  as  that  of  suggestion. 

The  peculiarity  of  the  latter  we  see  most  clearly  in  simple 
conditions.  Among  all  animals  living  together  suggestion 
plays  a  great  role.  If  one  of  a  herd  is  attacked,  the  dan- 
ger threatens  all  the  others,  or  at  least  it  would  be  better  for 
them  to  take  part  in  defense  or  flight.  If  food  is  to  be 
found  somewhere  it  is  well  if  the  whole  herd  know  of  it. 
Therefore  the  individual  animals  show  their  affect  as  soon 
as  they  scent  danger  or  food.  Immediately  the  same  affect 
with  the  same  expression  and  with  the  same  movements  of 
defense,  flight  or  acceptance  is  communicated  to  the  whole 
herd  so  far  as  they  can  perceive  through  their  senses  the 
affect  of  their  companions. 

In  this  there  need  be  absolutely  no  intellectual  content 
present;  what  is  suggested  is  only  the  affect,  the  anxiety, 
the  desire  to  fight,  the  pleasure  of  the  chase.*  In  higher 
animals  we  must  also  assume  that  the  place  and  kind 
of  danger  or  booty  is  communicated  at  the  same  time.     But 

*  In  the  case  of  man  it  is  presupposed  that  the  suggestor  can  suggest  an  affect 
which  he  himself  does  not  have.  But  one  can  not  compare  the  complicated  ex- 
perimental conditions  with  the  natural  functions  of  the  mind  and  can  only 
cautiously  draw  conclusions  from  one  to  the  other.  Speech  and  artificial  train- 
ing allow  the  use  of  means,  of  which  there  can  be  no  question  in  the  case  of 
animals  under  natural  conditions.  We  must  always  rememberthat  the  sugges- 
tion of  an  affect  to  a  person  who  is  not  trained  to  absolute  obedience  can 
scarcely  succeed  if  the  suggestor  does  not,  in  his  tone  at  least,  simulate  some- 
thing of  the  affect.  It  is  just  as  little  possible  to  suggest  sleep  by  giving  the 
words  in  a  merry  tone;  one  must  either  speak  monotonously  or  commandingly. 
In  the  suggestions  which  move  the  world  the  affects  of  the  suggestors  and  of 
the  suggested  are  moving  elements.  There  are  also  conditions  in  men  and 
animals  in  which  one  affect  in  one  person  calls  out  the  opposing  affect  in  another 
without  our  having  to  assume  an  intellectual  process  with  a  secondary  affect. 
The  anxiety  of  the  opponent  awakens  the  courage  of  the  aggressor,  and  vice 
versa.  We  have  no  reason  to  think  that  in  such  cases  another  mechanism  comes, 
into  action. 


43 

the  essential  thing  can  only  be  the  transmission  of  the 
affect;  the  communication  of  the  content,  the  intellectual 
part,  must  play  a  secondary  r6le.  This  we  see  in  the  dog, 
for  example,  an  animal  which  has  retained  very  little  of  the 
herd  instinct  but  which  is  very  accessible  for  suggestion 
from  other  dogs.  The  barking  of  one  awakens  similar,  i.  e. , 
affectively  similar,  barking  in  the  whole  neighorhood;  and 
yet  we  stand  near  enough  to  those  highly  developed  com- 
panions of  man  to  be  able,  from  our  observations,  to 
conclude  that  they  can  make  no  accurate  communication  in 
that  way.  We  find  suggestion  in  animals  only  in  the  case 
of  affects  or  occurrences  associated  with  affects  and  we 
have  good  grounds  for  concluding  that  the  animals,  the 
highest  classes  of  certain  genera  perhaps  excepted,  com- 
municate only  occurrences  associated  with  affects,  or  we 
might  say,  in  reality,  only  affects.*  The  communication 
or  the  description  of  the  cause  of  the  affect,  in  other  words 
of  the  intellectual  part,  is  probably  as  a  rule  unnecessary,  at 
any  rate  of  less  importance.  (Sometimes  it  is  implicitly 
contained  in  the  original  expression  of  the  affects,  that  is  the 
direction  of  flight  or  the  movement  of  attack). 

After  the  foregoing  the  purpose  of suggestibility  does  not 
especially  need  to  be  further  detailed.  It  causes  the  whole 
community  to  be  ruled  at  the  same  time  by  the  same  affect.  It 
causes  the  necessary  unity  of  action.  It  suppresses  all  other 
endeavors  of  single  individuals  so  that  the  energy  of  the 
actions  is  increased.  It  gives  greater  perseverance  to  the 
affect  and  then  to  the  efforts  which  we   make   because  the 


*  That  animals  communicate  experiences  to  each  other  which  have  no 
affective  meaning  for  them  will  be  maintained  by  no  one,  indeed  it  scarcely 
occurs  among  men.  Our  complicated  relations  conceal  the  affect  component 
which  depends  on  some  distant  association,  e.  g.,  the  teacher  instills  grammar 
into  his  students  because  his  living  depends  on  it ;  he  serves  his  nutrition- 
instinct  with  its  affects.  The  description  of  a  flower  is  given  on  account  of  its 
botanical  interest,  etc.  Many  call  the  blind  following  of  the  sheep  by  the 
other  sheep  suggestion  ;  it  might  appear  that  we  are  dealing  in  that  case  essen- 
tially with  an  intellectual  suggestion,  for  we  see  nothing  of  affect  in  it.  But 
we  do  not  know  the  instinct  which  causes  this  behavior.  Occasionally  they  fol- 
low some  passer-by  for  hours  and  can  not  be  driven  back  by  blows.  Kittens 
sometimes  also  show  the  same  phenomenon.  Chicks  who  have  just  hatched 
follow  not  only  the  brood  hen  but  also  the  first  moving  object  or  being  which 
they  meet.  These  analogies  make  it  very  probable  that  following  the  leader 
in  the  case  of  the  sheep  has  little  or  nothing  to  do  with  suggestion  in  contradis- 
tinction to  what  we  find  in  man. 


44 

individual  whose  efforts  threaten  to  weaken  is  again  turned 
to  the  original  task  and,  on  his  part,  he  then  strengthens 
others  in  the  general  affects. 

Therefore  suggestion  insures  unity  and  continuity  of  the 
affects  and  actions  of  a  community  by  pushing  all  in  a  cer- 
tain direction  and  suppressing  opposing  efforts.  While  the 
affect  promotes  in  the  individual  all  like  efforts  and  associa- 
tions, strengthens  and  prolongs  them,  suggestion  does 
exactly  the  same  for  the  herd.  It  takes  care  of  the  collective- 
affecf*  and  thereby  of  the  iinity  of  effort  and action.  We  may  add 
that  in  man  the  relation  of  individuals  among  one  another 
is  determined,  in  the  first  place,  by  the  affectivity,  even  if 
we  leave  out  of  consideration  what  we  call  sympathy  and 
antipathy.  One  can  see  this  in  exaggerated  form  and  in 
caricature,  and  therefore  all  the  more  strikingly,  in  the  in- 
sane. With  the  idiots  we  deal  much  as  would  a  father  with 
his  child  and  we  are  in  continual  affective  relations  with 
them.  Alcoholics,  general  paralytics,  manic  patients  find 
an  affective  response  with  us,  not  always  it  is  true  in  a  posi- 
tive sense,  but  we  understand  their  feelings  and  may  act  on 
them.  With  the  hebephrenic  who  intellectually  often  stands 
much  nearer  to  us  than  the  other  dements,  we  find  no  affec- 
tive rapport.  We  feel  towards  him  like  strangers,  very  much 
as  towards  a  bird  which  we  pet  and  which  allows  us  to  care 
for  it  but  never  allows  the  intimacy  which  we  quickly  reach, 
for  example,  in  our  relation  to  the  dog.  The  inhibited  and 
falsified  affect-expressions  of  the  hebephrenic  place  an  in- 
surmountable barrier  between  us  and  these  patients,  while 
all  the  intellectual  derangements  of  the  other  groups  do  not 
render  them  so  foreign  to  us. 

From  this  outline  it  follows: 

1 .  Under  simple  circumstances  affects  only  are  suggested. 

2.  Suggestion  has  exactly  the  same  purpose  for  the  com- 
munity as  the  affects  for  the  individual. 

3.  Animals  suggest  almost  only  affects.  Suggestion  in 
which  the  intellectual  content  plays  an  essential  role  occurs 
only  in  man,  and  even  here  is  not  frequent. 

*  I  would  define  this  collective-affect  as  only  the  sum  of  similar  affects  of  the 
individuals.  Psychological  units  which  extend  to  several  individuals,  such  as  a 
•collective  consciousness,  a  collective  will,  does  not  exist  in  this  sense. 


45 

And  at  the  beginning  we  established: 

4.  The  action  of  suggestion  is  shown  in  the  same  ways. 
and  under  the  same  circumstances  as  those  of  affects, 
whether  the  suggestion  be  an  intellectual  or  an  affective  one. 

One  may  conclude  from  these  facts  that  suggestibility 
can  not  be  separated  from  affectivity.  One  conception  must 
comprehend  both,  and  we  may  best  call  it  affectivity. 
Hence  we  can  express  our  knowledge  thus: 

Suggestion  is  an  affective  process:  Suggestibility  is  a  part 
of  affectivity . 

Thus  we  see  that  suggestibility,  in  the  original  affective 
form,  as  well  as  affectivity  in  the  narrower  sense,  is  active 
long  before  the  intelligence  is.  The  infant  very  early  under- 
stands the  affect-expressions  of  the  mother;  the  affect  of  the 
infant  not  only  influences  the  mother,  but  suggestion  very 
distinctly  acts  in  a  reverse  way.  If  the  mother  smiles  at 
him  the  child  is  also  disposed  to  smile,  all  the  expressions  of 
affection  not  only  make  an  agreeable  impression  on  him  but 
they  influence  his  mood  in  the  same  sense.  Reproofs,  even 
when  they  are  not  spoken  any  louder  than  the  pet  names, 
so  as  to  exclude  any  shock,  affect  him  in  the  opposite  way.* 
This  seems  self-evident;  but  it  might  be  otherwise. 

Even  in  the  infant  therefore,  perceptions  of  affect-expres- 
sions cause  a  similar  or  the  same  affect.  The  child  has  not 
only  an  innate  understanding  but  also  an  innate  resonance 
for  affect  expressions.  The  affect  is  transferred  to  the  child 
even  in  cases  in  which  we  can  not  imagine  any  intellectual 
content. 

With  older  children  it  is  well  known  that  the  play  of  others 
as  well  as  their  anxiety  or  weeping  is  "contagious,"  etc. 
With  adults  also  we  can  recognize  the  same  thing  in  all  the 
complications  of  a  civilized  life.  Therefore  the  suggestive 
transference  of  feelings  is  a  matter  of  common  observation. 

*  My  five  months  old  child  reacts  to  reproofs  spoken  in  a  low  tone  with  wrink- 
ling of  the  forehead  and  finally  by  weeping.  When  I  reprove  his  elder  brother  or 
when  the  latter  cries  from  pain  or  anger,  he  also  begins  to  weep.  With  expres- 
sions of  joy  or  simple  play  which  are  as  loud  or  even  louder  he  remains  entirely 
quiet  or  rejoices  also.  The  falsified  affect-expressions  of  a  hebephrenic  who  is 
in  my  family  have  been  from  all  time  without  effect  on  my  now  two  and  a  half 
year  old  boy.  Heregarded  her  interjections  as  a  natural  phenomenon,  not  as  an 
affect  expression.  They  found  in  him  no  response,  in  striking  comparison  to- 
the  affect  expression  of  normal  individuals. 


46 

While,  generally  expressed,  suggestibility  is  one  side  of 
the  affectivity,  we  also  see  in  special  instances  that  it  in- 
creases proportion ately  to  the  strength  of  the  existing  affect. 

A'igouroux  and  Juquelier*  express  this  general  rule  in  the 
words  '  'the  greater  the  feeling  value  of  an  idea,  the  more  is 
it  contagious. " 

Though  this  rule  may  appear  self-evident,  it  is  not  always 
so  at  the  first  glance.  An  affect  can  naturally  render  the 
acceptance  of  a  suggestion  difficult  as  well  as  easy,  accord- 
ing to  its  direction.  The  process  of  rendering  a  suggestion 
difficult  to  accept  is  also  a  result  of  suggestion.  We  can 
designate  it  as  a  negative  suggestion,  or  as  has  been  done 
in  the  case  of  hysteria  as  a  counter  suggestion.  The  mech- 
anism is  exactly  the  same  whether  it  acts  in  a  positive  or 
negative  direction.  From  an  unsympathetic  person  we  ac- 
cept suggestions  with  difficult}'-  while  one  is  only  too  easily 
influenced  by  those  of  a  beloved  person.  Or  we  receive 
evil  suggestions  about  a  person  whom  we  detest  readily, 
while  we  reject  calumnies  about  a  beloved  person." 

Although  it  is  easily  understood  that  one  who  is  perfectly 
indifferent  to  hypnotism  and  to  the  hypnotizer  can  not  be 

*La  contagion  merit  ale,  Ref.  Centralbl.  fur  Neurol,  und  Psychiat.  iqoj,p.  ijo. 
It  would  be  very  interesting  to  investigate  the  emotional  value  and  suggestive 
strength  of  different  ideas  which  have  been  active  in  civilization  and  especially 
in  politics.  An  example  taken  from  the  environment  of  the  writer  would  be  the 
comparison  of  the  politics  of  the  people  of  Berne  and  those  of  Zurich  in  Switzer- 
land. In  Berne  the  idea  of  the  state,  which  is  closely  connected  with  the  instinct 
of  self-preservation,  has  remained  dominant  through  the  centuries  and  now,  fifty 
years  after  the  foundation  of  the  new  confederation,  it  is  still  active.  In  Zurich 
there  are  many  and  far  reaching  ideas  which  individually  have  accomplished 
much  but  never  anything  which  has  remained  unchanged  in  the  course  of  time, 
and  when  the  new  confederation  was  founded,  Zurich  felt  that  it  was  only  a 
part  of  the  whole. 

t  An  apparent  exception  is  that  of  the  promptings  which  cause  jealousy.  One 
may  say  that  jealousy  is  itself  an  affect  which  favors  the  corresponding 
suggestion.  It  would,  however,  have  no  reason  for  existence  if  an  experi- 
ence or  an  accepted  gossip  did  not  first  produce  it.  Therefore,  although 
it  is  the  cause  for  the  acceptance  of  many  suggestions  it  is  nevertheless 
only  the  consequence  of  an  intellectual  process.  This  in  many  instances  depends 
upon  suggestions  the  acceptance  of  which  is  in  direct  opposition  to  love  and  re- 
gard. Consequently  the  affect  which  causes  the  jealousy  must  in  many  cases 
be  very  different  from  the  jealousy  itself.  Observation  of  jealousv  in  normal 
and  pathological  conditions  shows  that  different  kinds  of  affects  may  be  con- 
cerned. Sometimes  it  is  unsatisfied  love,  especially  in  women.  Most  frequently  it 
is  a  feeling  of  guilt  which  prompts  the  person  more  or  less  consciously  to  con- 
cede a  certain  right  to  adultery  to  the  other.  Hence  the  frequently  observed 
fact  that  those  men  who  allow  themselves  many  liberties  in  a  sexual  way,  guard 
their  wives  the  most  jealously. 


47 

hypnotized,  yet  the  conditions  caused  by  fear  of  hypnosis  are 
extremely  complicated.  To  be  sure  hypnosis  is  impossible 
in  the  majority  of  such  cases;  an  affect  does  exist,  fear,  but 
it  acts  in  a  direction  contrary  to  that  desired.  Fear  may, 
under  certain  conditions,  favor  hypnotism  in  an  indirect 
way.  Things  which  cause  the  fear  remain  in  the  foreground 
of  the  interest  and  inhibit  other  thoughts,  especially  when  a 
feeling  of  impotence  comes  in.  Thus  the  idea  of  the  thing 
feared  can  dominate  the  subject  and  drive  him  towards  the 
very  thing  which  he  fears.  This  is  an  everyday  occurrence 
which  needs  no  further  proof,  e.  g.,  the  squirrels  with  the 
rattle-snake.  Further,  with  fear  is  very  often  connected 
the  idea  of  domination  which  is  accompanied  by  strong 
feelings.  Such  affects,  which  unfortunately  have  no  name, 
play  a  great  part  in  many  suggestions.* 

When,  for  the  sake  of  experiment  we  hypnotize  a  man  and 
suggest  to  him  that  he  will  now  see  a  flower  or  a  mouse,  or 
that  after  waking  he  will  put  a  chair  on  his  head  as  a  hat, 
it  is  not  easy  to  see  the  affect  which  lies  at  the  bottom. 
The  single  suggestion  naturally  does  not  correspond  in  such 
cases  to  the  underlying  affect;  the  latter  causes  only  the 
acceptance  of  the  suggestion  under  the  given  condition. 
And  what  kind  of  an  affect  is  that?  Unfortunately  we 
have  no  name  for  it,  but  no  one  will  doubt  that  a  strong 


*  In  the  Neurological-Psychiatrical  Society  in  Zurich  where  I  mentioned  my 
conception  of  suggestion,  von  Monokow  reminded  me  that  there  were  also  imi- 
tations or  suggestions  in  the  present  day  sense  without  affects.  It  happens  that 
when  some  one  makes  a  cross  another  consciously  or  half  consciously  imitates 
him.  This  objection  showed  me  a  gap  in  my  reasoning.  I  do  not  believe  how- 
ever that  this  occurrence  says  anything  to  the  contrary  of  our  view.  The  imita- 
tion which  appears  without  affect  has  not  the  influence  on  our  pbj'siological  func- 
tions, or  on  ourlthoughts  that  true  suggestion  has.  It  is  therefore  different  from 
the  latter.  Further  every  idea  has  a  motor  component;  the  imitation  therefore 
is  nothing  extraordinary.  The  striking  thing  can  only  lie  in  the  acceptance  of 
the  idea  of  making  a  cross.  One  most  easily  receives  motor  ideas  by  the  sight 
of  some  action.  But  this  does  not  justify  us  in  classifying  the  imitation  in  this 
case  as  a  suggestion.  But  why  are  many  things  imitated,  others  not?  The 
choice  as  far  as  I  can  observe  is  always  an  affective  one;  that  which  harmonizes 
with  our  mood  or  has  some  relation  to  it  is  reproduced,  other  things  are  not 
(Compare  Freud's  mechanisms).  It  must  not  be  forgotten  that  there  exists  also 
an  instinct  of  imitation  which,  for  example,  in  the  mental  development  of  chil- 
dren, plays  a  great  part.  All  instincts  are  connected  with  affects  or  come  from, 
affects.  Imitations  without  any  affects  are  scarcely  ever  incoutestably  proven. 
Therefore,  as  far  as  we  know,  the  mechanisms  which  come  into  consideration 
agree  easily  with  our  conception.  The  relations  are,  however,  so  complicated 
that  a  definite  judgment  about  all  details  is  not  possible. 


48 

affect  underlies  the  feeling-  of  being  dominated  or  the  feel- 
ing of  authority.  This  affect  can,  on  the  one  hand,  be 
gradually  traced  by  imperceptible  steps  (in  the  majority  of 
men  in  relation  to  other  men)  to  the  affect  which  causes 
fright  palsy  ;  on  the  other  hand,  especially  in  women,  in 
their  relations  to  men,  to  a  sort  of  love,  inasmuch  as  here 
the  feeling  of  being  dominated  has  a  certain  sweetness, 
which  is  difficult  for  a  man  to  understand.  Both  kinds  of 
conditions  are  comprehended  in  the  term  fascination,  the 
affective  meaning  of  which  is,  to  be  sure,  not  yet  clear.* 

The  intellectual  as  well  as  the  affective  feeling  of  sub- 
ordination naturally  plays  a  great  role  in  the  well  known 
hyper-suggestibility  of  soldiers  (Bernheim  and  others). - 
Here  the  influence  of  habit  and  training  comes  into 
consideration  as  an  important  factor.  We  know  that 
suggestibility  may  in  a  certain  sense  be  increased  by  train- 
ing, just  as  we  see  that  the  affects  are  more  easily  liberated 
by  repetition.  By  means  of  practice  we  are  more  capable 
of  enjoyment,  in  the  field  of  art  and  natural  beauty,  for 
example,  even  when  the  intellectual  comprehension  makes 
no  real  progress.  Later  the  different  influences,  which  we 
call  collectively  blunting,  exert  their  inhibiting  effect.  In 
the  same  way  suggestibility  decreases  after  a  short  time 
when  the  suggestor  has  not  resources  enough  or,  as  in  the 
case  of  a  medical  suggestion,  occupies  himself  always  with 
the  same  narrow  theme,  in  short  if  he  is  unable  to  keep  the 
interest,  i.  e.  the  affectivity,  alive. 

In  the  increase  of  suggestibility  by  habit  there  is  another 
factor  which  must  not  be  forgotten,  the  simple  association 
through  practice,  a  more  intellectual  process.  For  example, 
a  horse  is  always,  in  a  certain  part  of  the  road,  made  to  trot. 
From  now  on  he  needs  no  more  urging;  as  soon  as  the- 
animal  comes  near  the  place  he  begins  spontaneously  to  trot. 
Every  German  with  any  education  at  all  will  associate 
with  "  Fest  gemauert  in  der  Ei'den,"  "  steht  die  Form  aus 
Lehm  gebrannt."  These  are  purely  intellectual  processes 
and  lead  finally  to  automatisms.  In  the  same  way  the 
practice   of   suggestion    must  lead    to    facilitation    of    the 

*  Vogt  ignored  this  affect  when  he  required  that  the  hypnotic  suggestion  must' 
be  without  affect. 


49 

process  and  finally  to  automatism.  Naturally  this  does  not 
conflict  with  our  views  of  the  affective  nature  of  suggestion 
but  it  furnishes  an  excellent  sample  of  how  complicated 
our  mental  processes  are. 

It  is  easily  understood  that  in  the  great  spheres  of  relig- 
ious and  political  convictions  the  affects  play  a  great  part, 
yet  they  often  act  so  indirectly  that  it  may  not  be  out  of 
place  to  devote  a  little  space  to  them. 

First,  do  suggestions  here  play  a  part?  Certainly;  from 
among  many  reasons  we  will,  however,  only  mention  the 
following:  None  of  the  creeds  comprehends  the  majority  of 
mankind.  If  any  creed  be  right  the  majority  must  necessar- 
ily be  wrong.  It  is,  however,  very  probable  that  no  creed 
is  right.  That  alone  shows  that  logic  has  little  to  do  with 
faith.-  And  as  a  matter  of  fact  political  and  religious  creeds 
are  only  in  exceptional  instances  determined  by  the  force 
of  logic,  but  usually  by  the  faith  of  the  environment,  and 
this  in  spite  of  the  fact  that,  in  political  questions  at  any 
rate,  there  are  enough  data  which  would  permit  any  educated 
person  to  form  a  fairly  objective  judgment.  While  in  the 
field  of  religion  we  find  that  the  dogmas  often  enough  con- 
tradict the  simplest  logic  so  that  one  would  think  they 
should  arouse  one's  critical  sense. 

There  are  many  affective  factors  which  give  to  religious 
and  political  influences  the  irresistible  force  of  suggestion. 
Here  I  will  only  mention  their  connection  with  the  love  for 
one's  parents,  with  many  memories  of  childhood  which  have 
a  strong  emotional  component,  with  the  most  important 
events  in  life,  and  last,  but  not  least,  with  the  care  for 
existence  in  this  world  and  for  salvation  in  the  world  to 
come.  What  strong  affects  may  originate  at  a  holy 
shrine  where  miracles  occur  can  be  imagined  by  any 
one  who  tries  to  render  these  conditions  clear  to  himself. 
Thus  it  happens  that  more  battles  are  fought  for  such 
matters,  which  are  questionable  from  a  logical  point 
of  view  but  which  have  a  great  affective  value,  than 
for  anything  else;  and  that  persons  who  are  otherwise  of  an 
unblemished  reputation  may  in  party  strife  use  rather 
questionable  means.     The  affect,   the    suggestion,  inhibits 


50 

here,  as  elsewhere  in  life,  the  opposing  associations,  the 
comprehension  of  the  right  of  other  views,  the  sense  of  the 
dubious  character  of  the  chosen  means  of  combat. 


The  role  that  affectivity  plays  in  auto-suggestion  is  clear. 
This  is  aroused  only  by  the  influence  of  strong  affects.  It 
is  as  yet  too  little  observed  in  healthy  individuals  because 
it  is  much  more  important  in  the  pathological  spheres  where 
it  often  dominates  or  even  causes  disease.  Charcot  showed 
the  connection  of  certain  forms  of  traumatic  hysteria  with 
fright,  which,  he  claimed,  produced  the  same  effect  as 
hypnosis.  Since  then  traumatic  neuroses  and  (functional) 
psychoses  have  been  attributed  to  suggestions  or  ideas  with 
a  strong  emotional  value.  The  example  cited  above  (page 
16)  of  the  man  injured  in  a  railway  accident  I  could  have 
presented  as  proof  of  the  strength  of  auto-suggestion  as  well 
as  of  the  affectivity.  Auto-suggestion  as  well  as  suggestion 
is  nothing  more  than  one  side  of  the  well  known  affect 
mechanism. 

It  is  obvious  that  also  in  non-pathological  conditions^ 
(anxiety,  also  pleasurable  affects)  ideas  which  correspond 
to  the  feelings  are  easily  accepted  without  criticism;  for 
example,  one  readily  interprets  every  noise  into  the  rolling 
of  a  wagon  when  he  is  tired  and  on  a  lonely  road,  and 
thirsty  people  on  the  desert  see  water  in  every  indistinct  spot 
of  earth. 

The  analogy  of  suggestibility  with  affectivity  is  also 
observed  in  the  fact  that  when  one  turns  his  attention  to  the 
mechanism  of  a  suggestion,  suggestion  is  rendered  difficult. 
The  similar  influence  of  attention  on  the  feelings  is  well 
known,  while  intellectual  processes  are,  on  the  contrary, 
assisted  by  the  exertion  of  the  attention. 

This  is  connected  with  the  much  misconstrued  and  yet  so 
easily  verified  fact  that  feelings,  as  well  as  suggestion, 
develop  their  greatest  action  in  half-conscious  and  uncon- 
scious processes.  A  person  may  joke  with  his  conscious 
mind  about  the  power  of  suggestion   and  yet  in   a  large 


51 

•gathering  on  the  simple  assurance  of  some  one  develop  a 
catalepsy  of  an  arm.  If  we  take  into  consideration  only 
that  which  takes  place  in  consciousness  we  will  never  be 
able  to  understand  suggestion,  and  just  as  little  will  we 
understand  the  important  mechanisms  which  Freud  has 
pointed  out  in  his  studies  of  hysteria,  in  dreams,  and  in 
every-day  life  and  which  dominate  a  great  part  of  our 
mental  life. 

>i<  %z  *  >j; 

Every  observer  has  noticed  that  pain-sensations  are  much 
more  accessible  to  suggestion  than  the  other  sensations.  It 
is  much  easier  to  suggest  analgesia  than  anesthesia  of  any 
other  sense.  In  hysteria  also  analgesia  is  more  frequent 
and  more  conspicuous  than  anesthesia.  The  difference  is 
shown  even  in  the  reflexes;  all  those  caused  by  pain  and 
disagreeable  sensations  are  frequently  lacking  in  this  disease, 
the  others  almost  never.  To  the  former  belong  the  twitching, 
the  changes  in  respiration  on  painful  stimuli,  the  reflex 
closing  of  the  eyelids,  the  pharyngeal-reflex,  etc.  We  also 
see  the  same  difference  in  katatonia  which  makes  use  of 
the  same  mechanisms  as  hysteria.. 

The  explanation  according  to  our  view  is  simple.  The 
ordinary  sense-perceptions  give  us  information  of  certain 
conditions  of  the  outer  world,  without  reference  to  the  mean- 
ing of  them  to  our  ego.  We  consciously  notice  only  a  small 
number  of  the  innumerable  stimuli  which  strike  our  senses, 
really  only  those  which  stand  in  connection  with  our  mo- 
mentary object.  The  same  music  which  captivates  us  in 
a  concert  we  may  completely  exclude  when  we  are  writing. 
The  selection  of  sensory  impressions  accords  with  our  inter- 
ests; it  is  determined  by  the  process  which  we  call  attention. 

It  is  entirely  different  with  pain.  Pain  turns  our  attention 
into  new  tracks,  forces  it  to  change  its  direction.  It  repre- 
sents an  injury  to  the  continuity  of  our  body  and  is  therefore 
a  most  important  occurrence  for  the  higher  animals.  Ordin- 
ary attention  is  powerless  against  the  diverting  power  of  pain, 

our  best  philosophy  does  not  avail  against  a  toothache." 
But  there  are  other  important  interests  for  the  organism  which 
under  certain  conditions  cause  suppression  of  pain.     In  a 


fight,  in  order  not  to  be  overcome  by  one's  opponent,  one- 
must  give  little  thought  to  wounds.  The  hungry  man  must 
not  consider  the  trouble  of  acquisition,  in  order  to  gain  the 
booty.  The  propagation  of  the  species  is  more  important 
than  the  preservation  of  the  individual.  The  male  dog  suf- 
fers hunger  and  mistreatment  for  many  days  if  he  can  in. 
that  way  approach  a  female  dog  in  heat.  All  these  impor- 
tant acts  are  accompanied  by  lively  affects,  the  strongest 
affects  corresponding  to  the  most  important  object.  Pain, 
therefore,  can  only  be  dissociated  by  ideas  with  a  strong 
feeling-tone,  or,  if  we  take  account  only  of  the  latter,  by 
feelings  and  affects.  Hence  pain  can  also  be  suppressed  by 
any  affect;  in  battle  the  soldier  does  not  notice  that  his  arm 
has  been  shot  off;  in  anxiety  one  sacrifices  something  of  the 
continuity  of  one's  body;  vanity  makes  cosmetic  operations 
more  or  less  painless. 

Naturally  we  can  not  say  that  in  every  given  case  the  sen- 
sory perceptions  are  turned  to  something  else  by  the  atten- 
tion, or  that  the  pain  sensation  is  inhibited  by  another  affect. 
Everything  psychical  is  too  complicated  to  be  expressed  by 
such  a  simple  formula.  We  must  not  forget  that  attention 
is  itself  determined  by  the  feelings,  and  the  feelings  them- 
selves may  be  deflected  from  an  important  perception  and 
suppressed,  etc.;  in  short,  the  two  kinds  of  influences  are 
never  entirely  pure  and  separate  from  each  other. 

Nevertheless  we  may  conclude  that  if  the  pain  perception 
can  be  directly  inhibited  by  feelings,  it  must  also  be  possible 
to  directly  influence  it  by  suggestion,  while  the  sensory  per- 
ceptions are  only  dissociated  in  an  indirect  manner,  and 
therefore  with  more  difficulty.  Perhaps  it  is  also  of  impor- 
tance that  by  the  testing  of  analgesia  and  anesthesia  the 
attention,  which  favors  the  sensory  perception,  is  excited 
and  is  a  counter-weight  against  the  suggestion  of  anesthesia, 
while  the  pain  sensation  is  much  more  independent  of  the 
attention. 

The  readiness  with  which  pain  is  influenced  by  suggestion 
illustrates  therefore  very  prettily  our  view  of  the  close  rela- 
tion of  suggestion  and  affectivity . 


53 

There  are  conditions  in  which,  in  spite  of  the  excited  af- 
fectivity,  suggestibility  may  be  suppressed  b}r  other  factors. 
Judgment  is  an  important  counterpoise  which,  to  be  sure, 
may,  even  in  intelligent  persons,  and  in  those  with  strong- 
characters,  be  dissociated,  although  this  is  rare.  If  the 
judgment  is  inaccessible  in  consequence  of  a  lack  of  associ- 
ations, whether  this  be  due  to  a  narrow  experience  or  to 
stupidity,  suggestibility  is  increased.  Thus  the  grade  of  sug- 
;gestibilit3T  is,  among  other  things,  a  (negative )  function  of 
the  power  of  criticism,  which  naturally  does  not  contradict 
the  view  of  its  affective  origin. 

We  have  a  high  degree  of  credulity,  and  every  idea, 
whatever  its  origin,  every  request  from  without,  every 
order  (this  also  as  a  result  of  education)  tends  to  force  us 
through  the  mechanism  of  suggestion  to  the  corresponding- 
action.  Therefore  judgment  would  easily  come  too  late 
were  it  not  for  the  fact  that  suggestion  has  an  automatically 
acting  counterpoise  at  its  side,  a  primary  tendency  to  turn 
aside  influences  from  without.  This  mechanism,*  to  which 
as  yet  little  attention  has  been  paid,  together  with  the  posi- 
tive forces  (including  suggestion),  regulates  our  actions  as 
antagonist  and  agonist,  and  is  one  of  the  roots  of  patholog- 
ical negativism  as  well  as  the  basis  of  contrary  suggestion 
which  plays  such  a  great  role  in  the  symptomatology  of  hys- 
teria and  other  diseases. 

It  is  in  suggestible  people  that  we  see  this  warding  off 
mechanism  mostly  developed  and  active  in  the  most  unsuit- 
able conditions.  Children  and  hystericals,  for  example,  are 
generally,  under  certain  conditions,  and  each  in  his  own 
way,  markedly  obstinate  and  headstrong.  This  may  re- 
present in  part  a  protective  mechanism  but  in  another  be 
analogous  to  emotional  lability,  the  expression  of  an  espe- 
cially strong  oscillation  around  the  position  of  equilibrium. 
Since  the  equilibrium  here  as  in  many  other  places  is  main- 
tained by  two  antagonistic  forces,  we  may  also  consider  the 
condition  of  increased  suggestibility  associated  with  the 
increased  inclination  to  negation  as  a  separation  of  the  yet 


*  More  fully  described  in"  Ein  psychologisches  Prototyp  des  Negativismus." 
'.Psychiatr.  Neurolog.  Wochenschrift,  1904-1905. 


54 

unknown  fundamental  property  into  its  (negative  and  pos- 
itive) ions.* 

In  order  to  fully  illustrate  the  connection  between  sug- 
gestibility and  affectivity,  we  should  be  able  to  prove  what 
kind  of  emotional  makeup,  what  "temperament"  is  most 
favorable  for  suggestion.  Unfortunately  we  can  not  do  this. 
Most  of  the  preliminary  conditions  for  such  an  investiga- 
tion are  lacking.  Suggestibility,  as  intelligence,  is  not  a 
uniform  quality;  in  certain  directions  a  man  is  strongly 
suggestible,  in  others  not  at  all  or  very  little. t  It  is  im- 
possible or  very  difficult  to  divide  mankind  according  to  their 
suggestibility,  even  when  we  have  good  cause  to  designate 
certain  persons  as  very  suggestible  and  others  as  little  sug- 
gestible. We  are  even  at  a  greater  disadvantage  when  we  try 
to  classify  the  affects  or  the  different  types  of  the  emotional 
makeup.  Here  we  know  only  a  few  mainlines,  e.g.,  the  type 
of  affectivity  which  in  excess  leads  to  mania  and  that  which 
leads  to  melancholia,  and  we  know  these  only  very  super- 
ficially. There  are  probably  sides  of  the  emotional  life  which 
we  divine  more  than  we  know,  yet  which  probably  play 
an  important  role.  I  would  refer  to  the  types  mentioned 
and  add  that  many  people  have  a  tendency  to  suppress  their 
disagreeable  affects,  z.  <?.,  as  far  as  possible  separate  them 
from  their  personality,  while  others  perfectly  amalgamate 
them  with  their  actual  personality  but  they  seem  at  different 
times  to  be  different  personalities;  the  one  dissociates,  as 
it  were,  the  affects  from  his  personality,  the  other  dissociates 
his  personality  according  to  the  different  affects.  To  me 
it  is  probable  that  the  former  are,  other  things  being  equal, 
little  suggestible  while  the  latter  class  is  accessible  in  a 
high  degree  either  to  suggestion  or  auto-suggestion  or 
both. 

Furthermore  we  know  that  children  with  their  lively 
affectivity  (and  undeveloped  power  of  criticism)  are  very 
suggestible.     In  manic  patients  with  the  same  temperament 

*  Freud  notes  in  his  " Dvei  Abhandlungen  zur  Sexual tlieorie'"  a  similar  con- 
dition in  sexuality  which  is  regulated  by  a  positive  force  and  a  negative  inhibi- 
tion. To  the  strong  positive  sexual  force  there  corresponds  a  strong  inclination 
to  inhibition.     (Anxiety,  etc.) 

+  An  energetic  officer  or  business  man  with  strong  convictions  may  be  under 
the  thumb  (suggestion)  of  his  wife,  his  mistress  or  indeed  of  his  servants. 


55 

we  see  similar  conditions.  We  know  that  the  affects  in 
melancholia  inhibit  the  associations  and  the  suggestions  in 
all  directions  which  are  contrary  to  the  inner  feeling'  but 
assist  those  in  harmony  with  it,  (religiously  indifferent 
melancholies  in  a  religious  atmosphere  also  acquire  re- 
ligious fears).  With  general  paralytics,  suggestibility  as 
well  as  the  affectivity,  is  increased  and  is  further  increased 
by  the  loss  of  the  critical  faculties.  In  dementia  praecox 
we  do  not  know  as  yet  what  kind  of  feeling-derangement  is 
present.  In  paranoia  (Kraepelin's)  we  have  a  mixture  of 
facilitated  and  inhibited  suggestibility.  In  the  traumatic 
neuroses  and  psychoses,  fright  and  different  apprehensions 
cause  the  symptoms  by  suggestion  and  auto-suggestion. 
But  this  is  as  far  as  we  can  go  even  here.  In  the  suggestion- 
disease  par  excellence,  hysteria,  we  know  little  of  that 
which  we  should  know  to  look  upon  suggestibility  and 
affectivity  from  the  same  point  of  view.  Nevertheless  it  is 
certain  that  in  hysteria  the  affects  play  a  great  role  so  that 
one  may  refer  the  hysterical  derangement  as  well  to  the  dis- 
sociating action  of  the  feelings  as  to  the  so-called  auto- 
suggestion, for  auto-suggestion  and  affect-action  here  appear 
identical . 

Even  leaving  out  of  consideration  the  mental  diseases, 
the  momentary  disposition  plays  a  very  great  role  in  suggesti- 
bility. The  inhibitions  and  facilitations  may  be  intellec- 
tual but  generally  they  are  affective.  Bodily  diseases  too, 
with  their  action  on  the  affectivity,  of  course,  influence 
suggestibility  (vide  the  persons  who  influence  invalids  into 
making  wills  in  their  favor) .  Exhaustion  as  is  well  known 
causes  the  same  thing.  Here  is  an  example:  A  very  in- 
telligent and  especially  impartial  and  objective  head-nurse 
returned  in  an  exhausted  condition  from  a  journey.  A 
nurse  met  her  and  informed  her  in  an  excited  and  dis- 
approving tone  that  a  certain  nurse  had  been  made  assistant 
head-nurse.  Like  the  nurse,  she  thought  that  the  choice 
was  a  misfortune  for  the  institution  and  an  injustice  to 
another  aspirant  to  the  place.  She  had  completely  for- 
gotten that  she  had  previously  approved  of  the  choice  and 
could  not  take  into   consideration  the   fact  that  the  nurse 


56 

had  only  accepted  the  position  after  the  other  candidate 
had  taken  it  and  had  resigned.  For  years  the  head-nurse 
could  not  resume  an  objective  attitude  towards  her  new- 
assistant,  and  although,  from  time  to  time,  she  admitted 
that  I  had  acted  entirely  in  accordance  with  our  agreement 
she  never  could  quite  forgive  me.  Grounds  for  jealous}^ 
were  entirely  lacking  in  this  case.  (In  contradistinction  to 
what  happens  in  paranoia,  the  delusion  has  not  broadened 

out). 

>!<  >;<  >'fi  ;;< 

The  matter  becomes  more  interesting  when  we  leave  the 
suggestion  of  the  individual  and  take  up  mass-suggestion, 
although  here  too  we  have  nothing  complete  to  offer,  for 
the  psychology  of  mass-suggestion,  in  spite  of  several 
attempts,  remains  yet  unwritten. 

Individual  suggestion,  especially  as  far  as  it  has  intel- 
lectual content,  is  a  miserable  artificial  product  which 
outside  of  human  conditions  has  little  influence. 

Suggestion  with  a  larger  complex  of  individuals  is  very 
different.  Here  it  corresponds  to  its  original  aim,  the 
shaping  of  a  strong  collective-affect  and  develops  also  its 
elementary  power  for  good  as  well  as  for  evil. 

A  great  mass  in  itself  inspires  strong  feelings,  even  an  in- 
animate mass  such  as  the  pyramids,  Mont  Blanc,  the  sea;  but 
not  so  much  as  an  animate.  Scarcely  any  one  can  deny 
the  imposing  impression  of  a  great  unified  mass  of  men. 
The  enthusiasm  for  the  army  would  certainly  be  much  less 
if  one  always  saw  only  individual  soldiers.  The  oath  of  an 
individual  can  at  most  through  especial  accompanying  cir- 
cumstances be  awe-inspiring,  while  the  oaths  of  14,000 
citizens  of  the  Landsgemeinde  in  Appenzell-Ausserrhoden 
is  in  itself  one  of  the  most  stirring  spectacles  which  one 
can  see. 

Mass  action,  especially  when  the  suggested  individual 
forms  a  part  of  the  mass,  causes  a  strengthening  through 
the  bare  number  of  suggestors,  which  must  act  in  a  manner 
similar  to  the  frequent  repetition  of  an  assertion.  At  the 
same  time,  to  a  view  which  is  shared  by  many,  more  cre- 
dence is  ariven  instinctively  and  with  a  certain  right  than  to 


one  which  only  a  single  person  believes.  Again,  the  indi- 
vidual who  is  a  part  of  such  a  human  complex  perceives 
■on  all  sides  sensory  perceptions  which  support  suggestion, 
while  those  that  invite  criticism  are  entirely  lacking  or  are 
present  in  unimportant  numbers. 

The  feeling  of  the  power,  even  of  the  irresistibleness,  of 
a  large  number  is  also  an  important  factor,  and  especially 
the  fact  that  many  inhibitions  which  would  naturally  tend 
to  counteract  the  power  of  suggestion  are  removed,  such  as 
embarrassment  of  the  individual  who  so  rarely  has  a  desire 
to  act  differently  from  the  environment.  The  same  feeling 
of  being  different  from  the  rest  which  in  the  individual 
hinders  suggestibility  forces  the  masses,  influenced  in  the 
same  sense,  to  an  acceptance  of  the  suggestion.  The 
diminution  or  the  removal  of  the  feeling  of  accountability 
for  acts  and  thoughts  diminishes  further  the  ethical  and  in- 
tellectual inhibition,  the  regard  for  others,  as  well  as  the 
personal  judgment. 

Thus  a  collection  of  individuals  has  another,  in  many 
respects  a  much  lower,  type  of  ethical  standards  than  the  in- 
dividual. One  can  see  indications  of  this  even  in  small 
committees,  but  for  larger  bodies  the  old  proverb  Senatores 
boni  vivi,  senatus  auteni  mala  bestia  is  always  more  or  less 
applicable.  That  the  ethical  standards  of  parties,  and  of 
States  does  not  come  up  to  even  modest  requirements  of  the 
individual  is  apparent  to  every  one.  The  latter  also  has 
another  reason:  ethics  regulates  the  behavior  of  the  indi- 
vidual in  regard  to  his  actions  in  the  community  of  which 
he  is  a  part  and  by  which  he  is  protected.  The  relation  of 
individual  countries  to  others  is  a  much  looser  one,  and 
it  is  therefore  lamentable  but  explicable  that  the  finer  ethical 
considerations  play  a  relatively  small  part  in  international, 
or,  for  that  matter,  in  national  politics.  From  a  utilitarian 
standpoint,  which  at  the  same  time  represents  the  phylo- 
genetic  point  of  view,  ethics  is  not  so  necessary  in  a 
collection  of  individuals  as  with  a  single  individual.  The 
bad  consequences  of  a  wrong  act,  (punishments!)  are  for 
the  culprits  generally  much  less  or  can  not  include  all  the 
participants. 


58 

The  number  of  such  factors  to  which  a  strengthening 
influence  of  masses  on  suggestion  must  be  ascribed  might 
be  increased.  The  essential  thing,  however,  will  be  the  de- 
velopment of  suggestion  from  conditions  of  a  large  unit  of 
individuals,  or,  the  phylogenetic  adaptation  of  the  function 
to  the  mass.  Thus  it  is  easily  understood  that  a  commu- 
nity not  only  thinks  and  feels  uniformly,  but  that  it  can  be 
much  more  easily  led  by  an  individual  than  a  single  person, 
as  soon  as  this  individual  has  found  an  affective  assonance 
in  a  great  number  of  the  individual  members  of  the  com- 
munity.* 

Thus  a  comparatively  poor  teacher,  even  an  inexpe- 
rienced kindergarten  teacher,  can  control  fifty  children  com- 
paratively easily  while  the  parents,  even  if  the3^  are  capable, 
may  have  trouble  in  directing  one  of  them. 


If  we  glance  over  the  action  of  suggestion  as  it  is  described 
in  books  on  r^pnotism  we  can  compare  it  step  by  step  with 
affectivity. 

In  the  sensory  sphere  we  daily  see  the  dissociation  of 
perceptions  by  the  affects.  One  overlooks  during  an  affect, 
many  occurrences,  even  severe  injuries  to  the  body  but  in 
both  cases  the  anesthesia  is  a  systematic  one  not  limited  to 
a  definite  sense  organ.  We  suggest  anesthesias  of  all  the 
senses.  On  the  other  hand  the  affects  allow  us  to  utilize 
occasional  perceptions  which  otherwise  we  would  not 
perceive  because  they  are  too  weak,  i.  e.,  suggestion  may 
cause  hyperasthesia.  The  affects  as  well  as  suggestion 
cause  illusions  and  hallucinations. 

The  motility  is  influenced  by  affect  and  suggestion  in 
the  same  way,  paralyses  and  cataleptoid  conditions  on  the 
one  hand  and  extraordinary  muscular  power  on  the  other 
are  engendered  by  anxiety  as  well  as  in  hypnotic  exper- 
iments. Both  functions  also  dominate  the  involuntary 
musculature,  the  blood  vessels,  intestines,  bladder,  etc. 

Affects  and  suggestions  dominate  the  actions  of  all  of  our 

*  A  preacher  likened  the  religious  edification  of  an  individual  as  compared  to 
that  of  a  crowd  to  the  burning-  of  a  single  stick  compared  with  the  powerful 
lire  of  a  heap  of  sticks.  The  picture  is  very  good  and  is  suitable  to  other  than 
religious  suggestion. 


59 

vegetative  organs,  the  heart,  lungs,  vessels,  glands,  men- 
struation and  many  other  functions.  The  influences  on 
metabolism  and  sleep  also  must  not  be  forgotten. 

They  influence  our  memory;  we  forget  or  transform  what 
is  disagreeable  and  keep  more  vivid  what  is  agreeable.  We 
find  memory-illusions  in  normal  individuals  as  soon  as 
affects  come  into  consideration;  they  are  more  frequent, 
however,  in  the  insane  whose  inner  life  is  dominated  by 
strong  affects,  and  we  produce  them  very  easily  by  suggestion . 

Our  whole  logic  is  controlled  by  affects  in  exactly  the 
same  way  as  by  suggestion  ;  both  render  criticism  difficult 
or  impossible. 

The  affects  change  our  personalities.  In  many  respects 
we  act  differently  in  sorrow  than  we  do  in  joy,  and  by  sug- 
gestion we  can  also  modify  the  character  of  a  person. 

In  the  domain  of  pathology  we  can  not  separate  the 
actions  of  the  affects  from  that  which  is  correctly  called 
auto-suggestion.  Whether  an  hysterical  is  delirious  because 
she  dissociates  the  pain  caused  by  the  loss  of  her  husband 
with  all  that  is  associated  therewith  or  because  she  makes  the 
auto-suggestion  that  he  is  not  dead  is  irrelevant.  It  is  only 
a  different  term  for  the  same  process.  The  wish-dreams  of 
normal  individuals  and  the  wish-deliria  of  the  insane  are 
nothing  but  the  consequences  of  auto-suggestion;  they  may, 
however,  also  be  described  as  actions  of  the  affects  which  in 
sleep  and  in  delirious  conditions  dominate  the  associations.* 

Attention,  whether  it  is  conscious  or  unconscious,  is  con- 
trolled by  "interest"  and  other  affects.  We  control  it, 
however,  just  as  well  by  suggestion.  We  dissipate  it  in  a 
hypnotized  person  who  is  in  rapport  only  with  his  hypno- 
tizer  in  exactly  the  same  way  as  it  is  in  the  case  of  the 
savant  who,  busied  with  some  problem,  does  not  notice  the 
storming  of  his  house. 

The  suggestions  a  echeance  are  also  referable  to  attention. 
If  we  set  ourselves  to  do  something  at  a  certain  time  or  at 
the  occurrence  of  a  certain  event  the  attention  is  consciously 
or  unconsciously  focused  on  this  event,  or  on  this  time.     At 

*  Compare  Binswanger,  Hysteria,  p.  78.  "At  least  a  perception  associated 
with  a  strong  affect  will  have  to  be  accorded  the  same  value  as  the  traumatic 
suggestions  which  are  often  hypothetical." 


60 

the  same  time,  however,  the  event  is  associated  with  the  act 
to  be  performed. 

Associations  and  inhibitions  are  therefore  put  in  readiness 
for  impressions  which  are  expected  in  exactly  the  same 
way  as  the  attention  does  it  for  actual  as  well  as  for  future 
experiences.  That  the  attention  is  directed  by  the  affect- 
ivity  has  already  been  mentioned  and  is  perfectly  obvious. 
The  suggestions  a  echeancc  therefore  need  no  further  explan- 
ation. 

Perhaps  it  is  necessary  to  add,  however,  that,  as  every- 
where in  psychological  matters,  different  ways  lead  to  the 
same  end  and  that  practically  the  result  is  never  influenced 
b>y  one  mechanism  only.  One  therefore  finds  many  other 
influences  acting  with  suggestion. 

The  latter  may  be  elucidated  by  an  analysis  of  the  action 
of  the  suggestive  questions. 

Stern  in  his  "Psychologic  der  Aussagc,"  asks  how  the 
suggestive  questions  act  and  has  "explained"  it  as  being 
the  imitation  of  the  mental  attitude  of  another.  But  why 
imitated  in  one  case  and  not  in  another?  That  is,  why  does 
not  every  suggestive-question  act  in  a  suggestive  manner. 
Simply  because  in  one  case  an  affect  is  present,  in  the  other 
case  not.  What  kind  of  affects  come  into  play  can  not  be 
generally  stated.  They  are  the  different  affects  which  the 
child  has  before  his  teacher,  or  the  witness  has  before  the 
judge  and  the  whole  situation  of  the  trial. 

But  other  things  come  in.  By  the  tone  and  form  of  the 
question  the  answer  can  be  suggested.  It  is  unpleasant  to 
have  a  different  opinion  not  only  from  that  of  one's  superior 
but  of  anyone  else,  and  we  instinctively  avoid  the  disagree- 
able. Thus  the  questioner  leads  the  associations  in  the 
intimated  direction.  The  simple  credulity  which  we  differ- 
entiated from  suggestion  may  also  play  a  great  part. 
Further,  the  refusal  of  the  insinuations  which  lie  in  the 
question  requires  a  certain  independence  of  character  and 
imagination  which  is  not  at  the  disposal  of  everyone.  In 
order  to  answer  the  question  whether  a  dress  was  blue  or 
yellow  by  saying  it  was  ' '  neither  blue  nor  yellow  but  red  ' ' 
requires  an  independence  of  mind  of  which  many  men  are 


61 

not  capable,  while  if  the  indifferent  question  were  asked, 
"'what  color  was  the  dress?"  the  same  men  would  have 
perhaps  answered  quite  correctly,  ' '  red  ' '  (Stern ) .  The  sug- 
gestive question  presents  a  definite  set  of  ideas.  This  is  of 
importance,  partly  in  a  direct  way,  because  the  person 
questioned  feels  more  or  less  forced  to  operate  with  the 
material  offered  to  him,  partly  indirectly  "because  owing 
to  the  natural  inertia  he  hesitates  from  voluntarily  amplify- 
ing the  whole  procedure  of  question  and  answer."  This  is 
the  case  in  the  question,  ' '  what  colored  dress  did  the  woman 
wear?  "  when  it  was  not  yet  determined  whether  a  woman 
was  present  or  not. 

Of  course  the  number  of  co-operating  motives  is  not 
exhausted  by  these  allusions.  Stern  also  emphasizes  the 
importance  of  the  tone  of  the  question.  'The  strongest 
suggestive  question  can,  if  asked  in  an  uncertain  timid 
voice,  lose  every  suggestive  force;  the  most  harmless 
question  asked  in  an  impressive  tone  accompanied  by  a 
fierce  look  and  repeated  with  ever-increasing  loudness  of 
voice  may  become  a  mental  torture  which  brings  forth  any 
desired  answer."  We  must  also  remember  that  we  all  have 
an  instinctive  feeling  of  compulsion  to  react  to  any 
question,  or  to  anything  which  is  said  to  us.  One  can 
conceive  this  quality  to  be  similar  or  identical  with  sug- 
gestion; in  both  cases  it  is  a  matter  of  an  emotional  and 
intellectual  rapport  between  two  individuals,  yet  it  is  not 
entirely  the  same,  whether  the  primary  individual  provokes 
in  another  simply  his  own  convictions  and  his  own  feelings 
or  whether  he  calls  forth  a  complement  of  his  feelings  or 

thoughts. 

*  *  #  * 

When  we  attempt  to  explain  the  phenomena  of  suggestion 
we  dare  not  entirely  ignore  hypnotism,  although  this  com- 
prises only  a  small  part  of  that  which  we  designate  by  the 
name  suggestion. 

Here  we  have  first  to  state  that  there  is  not  one  hypnosis 
but  a  whole  mass  of  conditions  to  which  we  give  this  name. 
What  is  common  to  all  of  them  is  a  more  or  less  complete 
exclusion  of  the  critical  attitude.     But  an  hypnosis  as  con- 


62 

ceived  by  Liebault  is  very  different  matter  from  an  hypnosis 
in  the  Salpetriere,  the  hypnosis  of  Braid  and  Mesmer  differs 
from  the  modern  hypnosis.  "The  suggestors  "  of  the 
modern  shows  produce  again  other  conditions.  Whoever 
has  seen  a  little  of  it  knows  that  with  the  same  technique 
the  condition  of  hypnosis  changes  with  every  hypnotist  and 
every  hypnotized  person. 

Therefore  what  is  essential  is  that  the  critical  attitude  is 
excluded  by  some  sort  of  emotional  impression,  by  fascina- 
tion, domination,  fright,  or  by  a  suggestion  which  depends 
on  these  affects.  All  other  symptoms  of  hypnosis  are 
accidental  suggestions  or  accidental  special  reactions  of  the 
individual  which  may  vary  from  case  to  case.  Whether 
the  subject  is  "conscious  "  or  not,  whether  he  is  in  a  sleep- 
like condition,  whether  he  has  amnesia  afterwards,  all  these 
are  entirely  irrelevant  matters  and  depend  on  accidental  or 
consciously  given  suggestions. 

When  the  school  of  Nancy  finds  a  resemblance  between 
hypnosis  and  sleep,  it  is  as  easily  understood  as  is  the  fact 
that  others  did  not  see  it.  Liebault  expressly  suggests  sleep 
and  to  the  medium  there  remains  nothing  else  but  to 
imitate  sleep  as  well  as  possible. 

The  exclusion  of  the  critical  attitude  by  the  affects  and 
also  by  suggestion  is  of  every  day  occurrence  and  we  need 
sa3^  no  more  of  it.  The  exclusion  of  other  idea-complexes 
we  see  not  only  as  the  action  of  the  affectivity  in  a  narrower 
sense  but  also  as  a  consequence  of  attention.  Thus  there 
are  no  phenomena  of  hypnosis  which  can  not  be  explained 
by  a  simple  inhibition  and  facilitation  in  the  same  way  as 
they  are  caused  by  the  affects.  But,  in  hypnosis  it  is  easy 
to  bring  about  exaggerated  results,  i.  e.,  to  produce  more 
than  is  needed  ;  the  affects  may  potentially  do  the  same  but 
actually  do  so  in  exceptional  cases  only,  i.  e.,  only  in  very 
profound  emotional  impressions. 


63 


PARANOIA. 


There  is  unquestionably  a  group  of  cases  in  whom 
■delusions  are  the  most  prominent  if  not  the  only  symptoms 
of  the  disease.  In  these  cases  a  system  of  delusions  gradu- 
ally develops  without  any  disorder  of  the  train  of  thought,  of 
will  or  of  action. ' '     (  Kraepelin) . 

In  this  sense  alone  will  the  expression  "Paranoia"  be 
used  in  the  following"  chapter. 

If  we  apply  our  conception  of  affectivity,  such  as  we 
have  developed  it  in  the  preceding  pages,  to  paranoia,  the 
doctrine  of  this  disease  must  appear  to  need  revision.  As 
an  example  it  may  be  well  to  enter  somewhat  intoSpecht's* 
views  on  paranoia,  which  he  has  recently  explained  in  an 
able  article.  But  these  views  seem  to  me  to  fail  particularly 
owing  to  his  lack  of  clearness  concerning  the  affects. 
The  author  will  pardon  me  if,  for  the  sake  of  brevity,  I 
•acknowledge  silently  the  good  that  I  find  in  his  work  and 
mention  only  that  which  departs  from  my  own  views.  I 
can  do  this  the  more  easily  because  while  our  paths  are 
often  in  opposite  directions  we  often  arrive  at  nearly  the 
same  conclusions. 

Specht  claims  that  paronoia  arises  from  the  pathological 

affect  of  suspiciousness."  According  to  him  this  affect 
consists  of  a  mixture  of  feelings  of  pleasure  and  displeas- 
ure, and  is  therefore  also  found  in  states  of  mania  and  mel- 
ancholia as  they  pass  over  into  convalescence  or  into  their 
opposites.  Paranoia  is  the  third  psychosis  to  postulate 
theoretically  besides  mania  and  melancholia. 

My  objections  to  this  are  : 

1.  Suspiciousness  is  not  an  affect. 

2.  It  is  not  a  mixture  of  pleasure  and  displeasure. 

3.  Paranoia  can  not  be  classed  with  the  affect  psychoses. 
I  thought  I  had  made  all  this  clear,  at  least  to  some  of  my 

colleagues,  in  an  article  in  the  Psychiatrische  Wochenschrift, 
1902-03,  p.  255,  but   have   evidently    not   succeeded,    al- 

*  Specht.  Ueber  den  pathologischen  Affect  in  der  chronischen  Faranoia.  Fest- 
schrift der  Univ.  Erlangen  Z.  F.  d.  So  J ahrigen  Geburtstages  Sr.  Kg.  Floheit 
des  Frinzregenten  Luitpold  von  Bayerti.  Erlangen  und  Leipzig.  Beichert, 
iqoi. 


64 

though  no  valid  objection  to  this  article  has  come  to  my 
notice.  I  may  therefore  be  pardoned  if  I  here  go  more  into- 
detail. 

Suppose  I  meet  a  young  man  in  a  neighborhood  which  is- 
not  free  from  robbers.  He  seems  to  be  a  student  and 
carries  a  botanical  specimen  case.  I  have  no  reason  either 
to  suspect  or  to  trust  him.  If  I  meet  a  farmer  with  his 
tools,  who  seems  to  be  orderly  and  who  has  horny  hands, 
I  trust  him,  I  feel  safer  with  him  than  alone.  If  I  meet  a 
man  whose  dress,  bearing  and  face  bears  the  stamp  of 
dissipation  I  mistrust  him.  I  do  not  know  that  he  will  do 
anything  to  me,  perhaps  he  is  a  harmless  tramp,  but  he 
might  nevertheless  be  after  my  money.  If  the  actions  of 
such  a  man  in  any  way  become  more  definite,  if  he,  in  an 
unmistakable  way  shows  a  revolver,  then  I  am  sure  that  he 
intends  to  attack  me. 

The  essential  thing  in  all  these  processes  are  perceptions 
and  interpretations,  therefore  intellectual  processes.  In  the 
case  of  the  student  I  think  neither  of  danger  nor  protection. 
I  know  the  farmer  is  not  dangerous,  I  know  that  the  one 
who  threatens  is  dangerous  ;  in  the  case  of  the  suspicious 
looking  individual  my  observations  and  conclusions  do  not 
suffice  to  decide  me  ;  on  that  account  I  mistrust  him.  I  can 
describe  the  process  in  pure  intellectual  expressions  without 
speaking  of  an  affect. 

It  is  of  course  understood  that  affects  may  enter  into  this 
occurrence  as  in  every  other  mental  process.  The  affect, 
however,  varies  quantitatively  and  qualitatively,  while  that 
which  is  designated  by  the  word  suspicion  remains  the 
same. 

If  a  person  suffers  from  dementia  praecox,  for  example, 
a  condition  in  which  the  affects  are  blocked,  the  fact  that 
his  life  is  threatened  may  be  a  matter  of  indifference  to 
him ;  the  corresponding  affect  ma3r  be  lacking  while 
suspicion  as  such  may  be  present.  In  a  normal  individual 
the  affects  are  never  entirely  lacking,  but  they  are  not 
exactly  the  same  with  any  two  men.  A  courageous,  a 
timid,  a  jolly,  or  a  depressed  individual,  and  whatever  other 
types  we  may  think  of,  differ  among  each  other  in  regard 


65 

to  the  feelings  associated  with  the  same  intellectual  process. 
In  a  depression  or  in  a  fighting  mood  a  person  may  even 
feel  a  certain  joy  in  a  situation  even  when  he  is  aware  of 
great  danger.  Further,  the  affects  change  according  to  the 
intellectual  content  of  the  suspicion,  i.e  .,  according  to  the 
threatening  danger,  even  when  the  suspicion  as  such 
remains  the  same  (whether  I  suspect  an  attempt  on  my 
life  or  on  my  purse,  the  suspecting  is  the  same).  If  I 
suspect  that  some  one  will  steal  my  purse  I  have  a  different 
affect  than  when  I  think  that  he  will  take  my  life  or  the 
life  of  one  of  my  family.  Or  if  a  person  threatens  to  sully 
my  honor,  I  have  an  entirely  different  affect  than  when  he 
uses  other  doubtful  means  against  me  in  the  struggle  for 
existence. 

Thus  affects  seem  to  be  quite  an  unessential  part  of  sus- 
pecting. They  may  vary  qualitatively  and  quantitatively, 
may  even  be  totally  absent  without  a  loss  or  change  of  the 
suspicion  as  such.  But  if  I  take  away  the  knowledge,  the 
intellectual  process,  there  remains  no  single  affect  which 
one  can  designate  as  suspicion. 

Suspicion  itself  therefore  can  not  be  an  affective  but  must 
be  an  intellectual  process.  After  all,  the  word  suspicion 
expresses  nothing  more  than  that  one  can  not  certainly 
foretell,  but  still  less  can  exclude  the  occurrence  of  an  event 
which  one  regards  as  unpleasant.  To  guess,  to  know,  to 
trust,  to  expect,  to  doubt,  to  be  clear,  to  be  certain,  to 
divine,  are  processes  which  are  quite  similar. 

In  the  examples  I  have  limited  myself  to  instances  in 
which  that  which  is  suspected  concerns  the  one  who  sus- 
pects. According  to  the  usage  of  the  language  I  should 
have  made  the  concept  much  more  comprehensive.  We 
may  suspect  that  a  rock  may  not  be  firm,  even  if  it  would 
not  injure  any  one  if  it  fell,  because  it  is  one  of  the  common 
qualities  of  a  rock  to  be  solid.  A  roue  may  suspect  that  a 
woman  may  not  be  virtuous,  although  he  would  like  it  if 
she  were  not.  We  may  suspect  an  enemy  even  when  by 
the  expected  attack  he  would  give  us  the  opportunity  to 
render  him  harmless  ;  or  suspect  that  a  person  might  injure 
our  enemy  although  we  may  be  bad  enough  to  enjoy  this. 


66 

In  all  these  cases  the  affect  is  even  more  non-essential 
because  the  supposed  disagreeable  thing  does  not  concern 
us.  Finally  the  affect  differs  also  according  to  whether  we 
suspect  an  object  or  a  person.  In  order  to  make  a  conces- 
sion to  the  conception  of  Sandberg  and  Specht  we  will, 
however,  abide  by  the  narrower  conception,  and  speak  only 
of  suspicion  in  reference  to  injury  of  one's  self  by  another. 
What  we  have  to  say  will  then  be  all  the  more  correct  when 
referring  to  the  usual  formulation  of  the  conception. 

As  already  stated,  suspicion  is  usually  accompanied  by 
an  affective  process.  Further  we  have  defined  it  as  the 
uncertain  expectation  of  something  disagreeable.  When 
an  accompanying  affect  is  present  it  is  naturally,  in  the 
majority  of  cases,  a  negative  one,  but  not  always  the  same 
one.  But  on  careful  observation  we  generally  find  that 
besides  the  negative  affect  there  exists  also  a  positive  one,  as 
in  the  case  of  an  affect  which  we  perceive  when  we  expect 
something  disagreeable  and  find  that  it  is  not  so  bad  as 
we  thought,  or  that  it  is  averted.  This  affect  is  probably 
similar  to  the  one  which  is  associated  with  hope.  Hope  is 
both  intellectually  and  affectively  the  best  counterpart  of  sus- 
picion. In  both  processes  indications  are  present  for  the 
realization  and  non-realization  of  a  definite  incident,  but 
they  do  not  suffice  for  a  definite  expectation.  In  such  a  case 
the  affect  changes  as  we  think  of  the  reasons  why  the  one  or 
the  other  outcome  should  result.  When  I  think  only  of  the 
reasons  which  cause  me  to  be  suspicious,  the  negative 
affect  is  much  stronger  than  when  I,  in  the  next  moment 
and  with  the  same  objective  knowledge,  place  in  the  fore- 
ground the  motives  which  srjeak  for  safety.  A  similar 
situation  we  find  in  hope.  The  affect  fluctuates  to  and  fro, 
not  spontaneously  but  in  correspondence  with  the  intellect- 
ual processes.  The  latter,  which  no  one  can  emphasize 
more  than  we,  are  of  course  also  inversely  influenced  by  the 
affects,  but  the  primary,  the  essential  factor  in  suspicion 
and  hope  is  the  intellectual  process.  Suspicion  is  almost 
always  accompanied  by  an  affect  belonging  to  a  definite, 
negative,  group,  but  not  by  a  definite  affect.  But  a  second, 
positive,  affect  also  plays  a  role,  and,  in  the  case  of  hope  it 


predominates.  Only  in  this  sense  can  we  agree  that  sus- 
picion represents  a  mixed  affect.  But  for  us  it  is  an  intel- 
lectual feeling-,  as  Nahlowsky  uses  the  term,  "an  objective 
process, ' '  accompanied  by  two  feelings  which  may  vary 
quantitatively  or  qualitatively  without  changing  the  nature 
of  the  suspicion. 

In  the  paranoia  question  there  is  yet  another  mistake. 
"When  Specht  and  Sandberg  claim  that  the  delusions  of 
persecution  arise  from  the  affect  of  suspicion,  they  mean 
that  there  is  a  lasting  affect  upon  which  develops,  in  the 
individual  case,  the  suspiciousness. 

Naturally  the  affective  disposition  is  here  as  elsewhere  of 
great  importance.  If  I  am  of  an  anxious  nature  or, 
through  some  occurrence,  am  in  an  anxious  mood,  I  turn 
my  attention  more  to  the  perceptions  which  point  to  danger, 
and  give  these  observations  a  great  weight  in  my  conclu-. 
sions.  If  I  am  courageous  or  in  an  indifferent  mood,  the 
intellectual  processes  are  changed  in  the  sense  of  these  dis- 
positions :  I  become  suspicious  only  with  much  graver 
indications. 

Therefore: — There  arc  certain  moods  in  which  suspicious- 
ness is  more  easily  engendered  than  in  others. 

Can  one  on  this  account  call  suspicion  an  affect?  Cer- 
tainly not.  There  are  different  moods  which  lead  to  the  same 
result,  such  as  anxiety,  hate,  the  feelings  of  displeasure  of 
all  sorts  by  which  the  suspected  person  arouses  suspicion  by 
his  appearance,  his  speech,  or  in  some  other  way,  for  with- 
out there  being  any  question  of  an  intellectual  process  we 
trust  a  sympathetic  person  more  than  an  unsympathetic 
one,  even  if  our  dislike  is  founded  on  something  entirely 
subordinate,  such  as  a  peculiar  nose  or  the  like. 

If  we  wish  to  designate  suspiciousness  as  an  affect,  we 
must  differentiate  it  from  the  affects  which  dispose  to  sus- 
piciousness. A  person  who  has  a  tendency  to  hilarity  need 
not  always  be  merry,  the  majority  of  comedians  are  said  to 
be  of  a  melancholy  temperament,  and  much  goes  to  show 
that  they  try  to  overcome  the  depressive  mood  by  their 
comic  productions.  In  manic-depressive  individuals  the 
same  disposition  leads  to  an  increased  readiness  to  elation 


68 

and  depression  ;  the  euphoric  mood  is  an  excellent  soil  for^ 
anger.     Thus  we  see  that  an  affect  which  is  aroused  by  a 
definite  occurrence    need  not  be  identical  with  the    mood 
from  which  it  arises. 

Just  as  an  emotional  so  may  an  intellectual  disposition 
favor  the  formation  of  suspiciousness,  such  as  the  occupa- 
tion with  the  thought  of  danger,  the  "feeling  "  (  i.  e.,  knowl- 
edge )  of  being  alone,  of  bodily  weakness  or  strength,  the 
consciousness  of  having  much  money  in  our  pocket,  etc. 

Moreover  the  simple  constellation,  here  as  everywhere 
else,  plays  a  great  part.  If  from  external  reasons  ( I  am  not 
speaking  here  of  the  disposition  caused  by  character  and 
mood)  we  have  to  think  much  in  a  definite  direction,  if  we 
have  much  associative  material  of  a  special  kind  at  our 
disposal,  our  thoughts  are  easily  turned  in  this  direction. 
Occupation  with  a  definite  topic,  whether  it  be  affect-full  or 
not,  always  causes  more  ideas  to  be  connected  to  it  than 
would  otherwise  be  the  case.  This  is  undoubtedly  one  of 
the  reasons  why  writers  of  monographs  overestimate  their 
subjects,  why  every  disease  with  which  we  occupy  ourselves 
a  great  deal  is  found  especially  frequently  ;  we  think  of  this 
diagnosis  more  frequently.  Thus  the  constellation  is  one 
of  the  most  important  causes  of  the  delusions  of  reference 
which,  to  be  sure,  are  also  favored  by  the  affect. 

/  believe  with  this  I  have  done  enough  to  establish  the  fact 
that  suspicion  is  not  an  affect  but  that,  as  every  other  mental 
process,  it  is  accompanied  by  affects.  These,  hotvever,  are  not 
constant  and  do  not  have  in  them  the  essentials  of  that  which 
we  call  suspicion.  Certain  moods  and  constellations,  however, 
favor  the  development  of  suspicion. 

This  also  includes  the  explanation  that  suspiciousness  is 
not  a  combination  of  the  affects  of  pleasure  and  displeasure, 
although  naturally  the  most  frequent  affect-state  in  suspi- 
cion is  a  fluctuation  between  positive  and  negative  affect. 

*  Bresler,  Psych.  Wochenshrift  III,  171,  assumes  that  through  a  disorder  of  the 
feelings  (which  inform  us  of  the  comfort  and  discomfort  of  the  ego)  patients  in 
the  initial  stages  of  paranoia  develop  an  uncertainty  and  therefore  a  suspicious- 
ness. Here  suspiciousness  would  also  be  a  result  of  the  emotional  disturbance 
and  not  the  emotional  disturbance  itself.  Of  this  hypothesis  of  Bresler  I  would 
only  state  that  the  disorder  of  the  emotions  in  paranoia  has  not  been  demon- 
strated except  in  so  far  as  it  refers  to  the  morbid  ideas. 


69 

There  yet  remains  to  prove  that  paranoia  can  not  be 
classed  with  the  affect-psychoses"  but  is  something  entirely 
different. 

This  part  is  most  difficult  for  me  because  I  am  to  prove 
something-  that  to  me  seems  very  evident,  or  otherwise  ex- 
pressed, because  I  can  not  put  myself  in  my  opponent's 
attitude. 

The  typical  affect-psychosis  is  Kraepelin's  manic-depress- 
ive insanity,  one  may  also  include  involution  melancholia 
and  the  "affective"  (manic  or  depressive)  states  which  are 
found  intercurrently  in  all  other  mental  diseases.  In  manic- 
depressive  insanity  the  emotions  are  in  an  unstable  equilib- 
rium, they  swing'  over  or  under  the  normal  or  both.  In 
the  other  conditions  we  scarcely  ever  find  a  stationary 
emotional  change  in  one  direction.  In  paranoia  alone  do  we 
meet  a  disorder  which  begins  insidiousl}7  and  which  pro- 
gresses during  a  whole  lifetime,  although  variations  occur. 
This  course  alone  speaks  against  a  parallelization  of  par- 
anoia with  the  affect  psychoses.  In  addition  to  that  we 
find  in  the  latter  affective  changes  before  the  delusions 
appear,  while  in  paranoia  we  would  have  to  assume  such 
affective  changes  b}^  means  of  a  very  doubtful  hypothesis, 
because  what  we  can  actually  observe  are  adequate  emo- 
tional reactions  to  delusions.  If  we  distract  the  patient's 
attention  from  these  we  are  unable  to  find  any  disorder  of 
the  affects.  On  the  other  hand,  in  mania  and  melancholia 
this  is  rarely  the  case,  and  then  only  in  the  milder 
instances. 

Again  Specht's  comparison  of  paranoia  with  the  affect 
psychoses  is  incorrect  because  it  is  not  true  that  the  mixture 
of  elated  and  depressive  moods,  in  the  convalescent  state  of 
acute  attacks  of  manic-depressive  insanity,  has  a  special 
tendency  to  cause  suspicion.  I  have  most  frequently  seen 
suspicion  during  the  depressive,  phase,  and  at  times  in 
mania,  while  in  the  convalescent  stage  of  the  latter,  irri- 
tability is  one  of  the  most  frequent  transformations  of  the 
manic  affect.  I  have  described  a  case  of  manic-depressive 
insanity  in  which  two  purely  depressive  phases  were  so 
dominated  by  suspicion  and  delusions  of  persecution  that 


70 

chronic  paranoia  was  diagnosed  by  a  competent  observer.*7" 
The  patient  had  exclusively  depressive  affects,  f  can  now 
add  that  he  has  since  had  a  rather  long  period  of  hypo- 
mania  Avithout  suspiciousness  from  which  he  recovered. 
The  mixture  of  manic  and  depressive  affects,  therefore;: 
does  not  produce  suspiciousness. 

Very  important  is  also  the  fact  that  manic  and  depressive  • 
patients  retain  their  affective  states  in  the  face  of  the  most 
varied  experiences.  The  worst  paranoic,  however,  connects 
his  suspicions  with  only  a  small  part  of  his  experiences. 
Therefore  if  an  affect  were  at  the  bottom  of  the  suspicious- 
ness, it  would  have  to  be  one  that  could  appear  and  vanish 
from  minute  to  minute,  I  could  almost  say,  from  second  to 
second.  A  paranoic  may  not  only  hear  a  whole  sermon  but 
he  may  associate  for  weeks  with  others,  while  of  all  of  the 
experiences  of  this  time  only  a  single  sentence  from  the 
sermon  will  be  interpreted  in  the  sense  of  his  suspicions  or 
of  his  delusions;  therefore  a  condition  quite  different 
from  what  we  see  in  the  affect  psychoses.  But  the  sus- 
piciousness is  lacking  not  only  in  connection  with  a  great 
majority  of  experiences,  but  every  paranoic  shows  with  his 
distrust  of  individual  persons  at  the  same  time  a  trust  for 
others  which  has  just  as  little  ground.  I,  at  least,  have 
not  observed  any  paranoic  who  did  not  show  this  s3rmptomv 
which  as  time  went  on,  changed  to  hate  if  the  person 
who  had  formerly  been  trusted,  did  not  fulfill  his  wishes. 
Kreepelin  describes  the  same  phenomenon  in  paranoia 
quaerulans  as  pathological  credulity. t 

And  last  but  not  least,  the  paranoic,  in  pronounced  cases, 
is  not  at  all  dominated  by  suspiciousness.  We  will  not 
speak  of  the  other  forms,  but  even  the  person  with  delusions 
of  persecution  as  a  rule  does  not  suspect,  he  knows  that  he  is 
persecuted  and  is  so  sure  that  a  normal  individual  scarcely 
knows  anything  more  certainly.  A  discussion  with  him  is 
often  absolutely  out  of  the  question,  for  him  there  is  no 
reason  which  can  be  advanced  against  his  views. 

*  Psych.  Wochinschrift.    1902,  No.  11. 

•  Wnm  also  the  normal  opposition  of  belief  and  caution  which  otherwise- 
governs  <>ur  attitude,  is  so  far  changed  that  both  forces  seem  increased,  or  ■ 
act  separately  without  the  possibility  of  mutually  diminishing  each  other. 


71 

If  we  take,  however,  the  paranoic  not  with  ideas  of  per- 
secution, but  the  great  class  of  cases  with  delusions  of 
grandeur  we  find  in  the  foreground  the  opposite  to  suspi- 
ciousness, a  great  trustfulness  and  hopefulness,  to  be  sure 
only  seldom  directed  toward  others,  but  generally  referring 
to  the  patient's  own  efforts  and  discoveries.  Nevertheless, 
it  is  characteristic  for  the  opposite  of  distrust  that  an  erotic 
paranoic  will  only  infrequently  get  the  idea  that  his  beloved 
is  unfaithful  to  him  even  in  spite  of  her  repulses. 

While  we  see  that  not  all  paranoics  are  distrustful  we  can 
on  the  other  hand  observe  that  there  are  very  many  dis- 
trustful persons  who  never  become  paranoic.  I  know  of  a 
woman  who  has  remained  single  simply  because  she  can  not 
trust  any  man  enough  to  marry  him.  She  can  scarcely 
purchase  anything  in  a  shop  because  she  fears  that  she 
will  be  cheated.     She  is  not  paranoic. 

Therefore  paranoia  can  exist  without  suspiciousness  and 
excessive  distrust  docs  not  necessarily  lead  to  paranoia.  Con- 
sequently paranoia  must  be  rooted  in  some  other  quality. 

In  conclusion :  Suspicion  is  not  an  affect.  Paranoia  on 
account  of  its  different  course  can  not  be  placed  among  the 
affect  psychoses,  hi  many  patients  with  dehisions  of  persecu- 
tion we  find  associated  with  suspiciousness  an  abnormal  trust 
in  some  other  individuals .  Paranoics  with  ideas  of  grandeur 
and  similar  delusions  do  not  have  an  excessive  suspiciousness . 
And  even  in  paranoia  persecutoria  the  suspiciousness  has  a 
conspicious  role  only  in  the  beginning  of  the  disorder  and  even 
the7i  not  always.  In  the  fully  developed  para?wia,  on  the 
other  hand,  the  unshakable  and  indisputable  knowledge  {the 
delusion}  sta?ids  in  the  foreground.  Suspiciousness  does  not 
lead  to  this  certainty  but  stands  in  a  certain  contrast  to  it. 


I  would  like  to  briefly  review  a  few  other  points  in 
Specht's  work  which  seem  to  me  to  require  special  discus- 
sion. But  it  is  impossible  to  go  over  all  that  has  been 
written  of  the  genesis  of  paranoia. 

Page  5.  "It  is  a  pity  that  the  primordial  deliria,  in  spite  of  the 
fact  that  they  were  first  described  by  Griesinger,  prove  to  be  more 


12 

and  more  an  unfortunate  invention."  I  must  admit  that  I  doubt  the 
existence  of  ' '  primordial  deliria  ' '  in  paranoia.  Unfortunately, 
however,  we  can  not  as  yet  genetically  explain  all  the  apparently 
autochthonous  ideas  in  dementia  praecox  which  later  become  fixed 
delusions,  and  therefore  we  can  not  as  yet  dispense  with  either  the 
name  or  the  conception.* 

Page  S.  According  to  Specht  only  false  ideas  whose  central  point 
is  the  ego  are  delusions.  "It  is  therefore  not  a  delusion  when  a 
patient  considers  a  pebble  to  be  a  diamond. ' '  But  is  it  a  simple  error  ? 
I  do  not,  at  present,  know  of  any  other  name  for  such  a  phenome- 
non. I  have  given  several  examples  of  delusions  which  are  not 
ego-centric  in  the  Psych.  Wochenschrift,  1901-02,  page  256.  If  Neis- 
ser  {Ceniralblatt  f.  Nervenheilk  und  Psych.,  XXVI,  230)  considers 
my  ideas,  ' '  especially  as  far  as  they  contradict  the  ego-centricity  of 
the  paranoic  delusions,"  as  invalid  he  has  read  incorrectly  for  I 
speak  there  of  delusions  which  are  not  ego-centric  only  so  far  as  de- 
mentia praecox  is  concerned,  and  therefore  do  not  materially  differ 
from  his  opinion.  What  I  say  is,  that  at  present  we  have  no  right  to 
limit  the  name  delusion  to  ego-centric  delusions  as  Specht  does. 
However,  for  question  in  hand  this  is  not  essential. 

I  would  like,  however,  to  call  attention  to  the  fact  that  the  example 
of  Specht  on  page  10  is  incorrect.  ' '  One  may  believe  in  witches  but 
not  that  one  is  bewitched  without  raising  a  suspicion  of  insanity." 
Waldau  Asylum,  where  I  was  assistant  physician  for  several  years, 
draws  its  patients  from  regions  where  the  belief  in  witches  (capuchins, 
etc. )  is  yet  prevalent.  A  person  from  such  a  place  naturally  assumes 
the  possibility  of  such  influences  in  his  own  case,  especially  when  a 
striking  disease  or  an  accident  gives  him  occasion.  In  Burgholzli  we 
get,  for  the  most  part,  people  who  do  not  believe  in  witches.  Any 
one  in  this  region  who  believes  in  witches,  whether  he  imagines  him- 
self bewitched  or  not,  is  usually  either  pathological  or  distinctly 
insane.  The  difference  between  the  morbid  idea  and  error  here  lies  in 
the  origin  ;  in  the  latter  case  a  development  of  an  independent  trend 
not  in  contact  with  reality,  paresthesias,  peculiar  feelings  in  regard 
to  the  train  of  thought  (such  as  a  feeling  of  blocking  or  of  being 
obsessed,  compulsive  actions,  etc. ) ;  in  the  first  case  :  the  influence  of 
a  general  suggestion  which  only  an  especially  strong  mind  can 
resist. 

The  utterance  of  one  of  Ziehen's  patients  "the  universe  becomes 
fat,  black  is  not  black,  te  deum  laudamus  ' '  which  is  evidently  that  of 
a  paranoid  hebephrenic,  can  not  be  discussed  in  this  connection 
because  no  one,  without  a  further  analysis,  has  any  idea  what  the 
patient  wanted  to  express,  perhaps  it  was  something  which  in  the 
speechof  normal  individuals  can  not  be  expressed  at  all. 

*  In  the  next  volume  of  the  Zeitschrift  f.  Psychol,  and  Neurologiey  Drs.  Jung 
and  Riklin  will  show  that  the  mechanism  of  the  origin  of  this  kind  of  delusion 
can^be  traced  further  back. 


73 

Page  10.  That  "our  consciousness  would  be  without  a  real  founda- 
tion if  it  were  not  supported  by  the  immediate  experience  of  the  ego 
which  is  given  to  us  by  our  feelings  "  must  yet  be  proven  even  if  the 
feelings  in  many  respects  appear  to  be  the  most  essential  part  of  the 
ego.* 

Indeed  the  term  "immediate  experience  of  the  ego"  seems  to  me 
to  be  based  on  a  misconception.  In  our  mind  there  are  no  other 
than  immediate  experiences.  Of  these,  those  received  through  the 
-senses  as  well  as  the  hallucinations,  are  secondarily  projected  out- 
wards. Those  which  are  not  thus  projected  belong  to  our  inner  ex- 
perience. I  can  not  understand  how  in  these  two  chief  classes  or  in 
addition  to  them  there  can  be  an  immediate  and,  for  that  matter,  a 
mediate  experience  of  the  ego. 

On  pages  12-13  Specht  regards  the  feelings  of  rnorbid 
self-reference  as  a  process  of  perception  in  which  the  sensory 
stimulus  must  co-operate  with  reproduced  sensory  material 
which  already  appertains  to  the  personality.  "The  sub- 
jective complement  is  an  indispensable  essential  of  every 
clear  perception  and  the  morbid  self-reference  is  only  a 
special  instance  of  this  association  process.  Since  I  have 
found  that  this  or  that  occurrence  has  for  me  this  or  that 
meaning,  every  similar  experience  must  with  psychological 
necessity  call  up  the  self-referring  associations."  In  the 
"for  me"  there  is  an  unsuitable  generalization.  It  is 
indeed  correct  that  our  psychological  experiences  are 
essentially  our  own,  but  there  is  a  great  difference  between 
the  experience  in  the  perception  of  an  object  or  an  incident 
which  we  attribute  to  all  others  and  the  reference  of  the 
perception  to  the  ego,  i.  e.,  the  normal  and  morbid  self- 
reference  of  which  Specht  further  says  :  "This  process  only 
begins  to  be  abnormal  when  it  appears  frequently  and  with 
evident  one-sidedness.' '  What  is  here  added  to  the  sensa- 
tion is  something  entirely  different  from  that  which  is  added 
when  I  refer  the  appearance  of  a  man  or  object  to  myself. 
In  one  case  I  simply  add  to  the  sensation  something  which 
always  belongs  to  it  and  which  others  add  to  it  under  the 
same  circumstances,  in  the  other  case  I  add  an  accidental 
reference  to  myself. 

According  to  Specht  the  most  important  thing  in  West- 
phal's  soldier  who,   when  wearing  a  new  uniform,  thinks 

*  Many  school  teachers,  who  think  a  man  consists  only  of  memory  and  perhaps 
also  of  a  little  intellect,  forget  this. 


74 

himself  observed  by  everybody,  and  Cramer's  partly  dressed 
man,  is  that  they  ascribe  a  certain  approving,  admiring, 
scornful  or  hateful  tendency  to  the  looks  of  the  people  who 
see  them,  and  this  side  of  the  phenomenon  finds  its  explan- 
ation of  course  only  in  the  mood  of  the  one  who  thinks 
himself  observed. 

This  is  not  necessarily  so. 

I  remember  similar  situations  where  I  (wrongly)  assumed 
I  was  observed  partly  in  direct  opposition  to  conscious 
reflection.  The  valuation  by  those  about  me  of  my  person- 
ality or  clothing  was  quite  in  the  backgroud  if  it  played 
any  role  in  the  "feeling  of  being  observed."  The  essential 
thing,  according  to  my  experience,  is  that  I  am  constantly 
occupied  with  the  idea  of  new  clothing,  the  new  dignity, 
or  with  the  defective  clothing.  I  continually  feel  and  see 
the  unusual  clothing  and  my  whole  endeavor  to  cover  up  the 
defect  determines  my  behavior  and  therefore  occupies  my 
mind  to  a  considerable  degree.  Everything  that  we  do  in 
such  a  case  touches  continually  a  part  of  the  actual  (also 
unconscious)  association-complex  of  the  clothing.  If,  at 
this  time,  some  one  talks  of  philosophy  or  politics  we  scarcely 
connect  these  themes  with  the  idea  of  clothing,  but  if  any 
one  looks  at  us  even  in  the  most  ordinary  and  casual  fashion, 
that  usually  would  be  unnoticed,  these  looks  are  referred  to 
the  associations  nearest  and  constantly  at  hand,  viz.:  to  the 
ideas  of  clothing,  the  overvaluation  of  which  is  transferred, 
according  to  well  known  rules,  to  the  closely  associated 
ideas  of  being  observed. 

In  such  cases  it  is  therefoi'e  a  matter  of  constellation. 

Inversely  :  On  a  journey  I  wear,  for  comfort,  a,  to  me, 
very  pleasing  but  at  the  same  time  a  rather  striking  suit. 
Since  I  am  comfortable  I  do  not  notice  it.  I  know,  however, 
that  others,  especially  those  who  know  me  may  possibly  make 
fun  of  me  about  it.  This  I  am  able  to  put  up  with  without 
however  being  indifferent  to  it.  Nevertheless  I  develop  fewer 
ideas  of  reference  than  one  would  expect  under  the  circum- 
stances. Since  the  thought  of  my  clothing  is  lacking,  I  do 
not  associate  the  looks  of  the  passers-by  or  my  fellow-trav- 
elers to  my  clothing,  and  when  another  thought  is  aroused 


75 

in  me  they  are  not  associated  at  all  and  therefore  remain 
unnoticed.  Here  the  unusual  constellation  which  pro- 
duces the  singular  reference  to  self  is  lacking. 

One  can  naturally  say  that  I  have  connected  the  stronger 
affect  with  the  stronger  feeling  of  reference.  I  believe, 
however,  that  I  am  sufficiently  able  to  observe  myself  and 
feel  convinced  that  my  view  is  correct. 

If  we  look  about  us  we  will  find  thousands  of  cases  of 
the  inclination  to  connect  new  experiences  to  an  idea  which 
occupies  us  at  the  time  (writers  of  monographs!).  It  is 
quite  natural  that  an  affect  plays  a  part  in  this,  for  the 
affect  gives  rise  to  overvaluation  of  an  idea*  and  often 
forces  us  to  occupy  ourselves  with  it.  But  even  then  it  is 
not  necessary  that  the  affect  be  the  cause  of  the  association 
between  the  new  impression  and  the  existing  complex.  It 
only  accounts  for  the  continuous  presence  of  the  idea  so 
that  an  incoming  stimulus  finds  it  ready  and  becomes 
associated  with  it.  The  soldier  notices  the  looks  of  the 
passers-by  because  his  pride  or  the  unusualness  of  his  new 
clothes  keeps  the  idea  always  in  the  foreground,  not 
because  he  ascribes  to  his  fellow  men  a  tendency  to  admire 
him.  The  person  with  the  defective  clothing  may  be  quite 
certain  that  those  he  meets  take  a  sensible  view  of  it  or  are 
wholly  indifferent  to  it,  but  as  long  as  he  thinks  of  his 
defective  clothing  he  feels  that  he  is  being  observed  more 
than  he  ordinarily  would. 

Therefore  there  does  not  need  to  be  any  affect  to  produce 
a  physiological  feeling  of  reference.  It  is  sufficient  that 
any  idea  be  constantly  in  the  foreground  (frequent  occupa- 
tion with  some  definite  object,  for  example),  for  the 
chances  of  its  association  with  new  incoming  impressions- 
to  be  increased  almost  indefinitely.  In  spite  of  the  great 
importance  of  the  affectivity  the  action  of  the  constellation 
in  the  associative  processes  must  not  be  entirely  over- 
looked. 

Page  15.  The  morbid  self-reference  according  to  Specht  occurs 
only    in   psychoses   with   emotional   abnormalities.       But   are   there 


*  I  use  this  expression  in  a  somewhat  wider  (not  pathological)  sense  than  its- 
originator,  Wernicke,  did.  , 


76 

psychoses  without  emotional  abnormalities,  since,  he  has  attributed 
paranoia,  the  intellectual  psychosis  par  excellence,  to  siich  abnormal- 
ities? 

Page  16.  Specht  should  have  defined  more  clearly  what  he  means 
h>-  the  ' '  Steigerung  des  Selbst-gefiihls  ' '  (something  like  a  heightened 
feeling  of  self),  which  according  to  him  is  the  foundation  of  the  de- 
lusions of  grandeur.  For  me,  at  least,  the  expression  has  no  clear 
meaning  unless  it  be  simple  overrating  of  one's  own  powers.  When 
a  person  thinks  that  he  is  better  than  he  actually  is,  it  is  not  an  affect 
but  a  question  of  internal  or  external  perceptions  or  of  false  con- 
clusions. Yet  it  is  an  intellectual  process  which  very  easily  arises  as 
a  result  of  an  exalted  mood. 

Page  16.  That  ever}*  paranoic  has  delusions  of  grandeur  is  doubtful. 
Many  with  ideas  of  persecution  only  place  their  personality  into  the 
foreground  in  so  far  as  it  is  a  natural  result  of  the  idea  of  persecu- 
tion. Every  normal  individual  Avho  is  persecuted  does  the  same,  al- 
though not  in  a  paranoicly  exaggerated  fashion.  At  any  rate 
delusions  of  persecution  are  not  conceivable  without  producing 
secondarily  that  which  we  might  call  delusions  of  grandeur.  (Com- 
pare our  first  case) . 

On  page  21,  Specht  asks  why  we  are  so  set  on  regarding 
the  emotional  disorders  as  secondary  when  even  the  pa- 
tient's own  statement  goes  to  show  that  this  is  not  so.  The 
answer  is  very  simple  ;  we  do  not  see  the  primary  emotional 
disorder.  A  paranoic,  when  once  his  delusions  are  formed, 
appears  to  us  to  be  emotionall}"  normal.  What  we  see  in 
him  in  this  respect  appears  to  be  a' normal  reaction  to  his 
('false.)  ideas.  If  we  say  nothing  to  him  of  his  delusions 
we  notice  no  abnormality  in  his  moods,  even  if  we  know 
it.  All  his  affects  appear  to  be  those  of  a  healthy  man. 
It  is  entirely  different  in  a  depressed  patient  or  in  a  manic 
patient.  Here  even  to  the  casual  lay  observer  the  emotional 
disorder  dominates  the  picture.  It  shows  itself  in  indif- 
ferent conversation,  as  well  as  in  conversation  about  the 
delusions,  only  in  the  latter  case  it  may  be  increased. 
Since  we  can  not  observe  the  emotional  disorder  in  paranoia 
it  is  hard  to  assume  it,  as  far  as  it  is  a  question  of  a  general 
emotional  disorder  as  Specht  and  others  say. 

It  is  also  contrary  to  my  experience  when  Specht  on  page 
22  says  that  the  paranoic  with  delusions  of  persecution  at 
the  height  of  his  disease  is  more  or  less  dangerous  to  the 
community.     According  to  him  this  could  not  be  explained 


77 

if  their  feelings  were  normal,  but  in  that  case  every  jealous 
husband,  every  person  who  had  a  grievance  must  also  be 
dangerous.  In  the  first  place  it  must  be  noted  that  many 
paranoics  never  become  dangerous  to  the  community  (these 
are  seldom  seen  in  an  asylum)  and  that  there  are,  after  all, 
very  few  non-paranoic  individuals  who  for  years  and  years 
have  been  persecuted  with  such  persistency  and  chicanery 
as  a  paranoic  thinks  he  is,  but  nevertheless  even  such  an 
individual  may  get  to  a  point  where  he  commits  murder. 
In  this  respect,  therefore,  so  far  as  one  can  judge,  the  par- 
anoic acts  scarcely  differently  from  a  normal  person,  and  it 
is  certainly  a  mistake  to  judge  from  an  occasional  reaction 
of  this  sort,  that  there  exists  a  general  emotional  abnor- 
mality. 

It  is  also  incorrect  to  say  that  every  normal  man  becomes 
indifferent  to  continual  persecutions.  Many  become  more 
excitable  and  react  only  after  years.  We  have  in  the  hos- 
pital now  a  very  nervous  but  not  paranoic  man  who  was 
constantly  tormented  by  his  wife,  but  only  shot  her  after 
seven  years  of  this  life  ;  and  how  numerous  are  the  cases  of 
persons  who  only  after  years  of  ill-treatment  get  to  the  point 
where  they  leave  their  positions. 

Page  25.  '  The  subjective  situation  is  correctly  outlined 
if  we  regard  the  general  idea  of  being  persecuted  as  such  a 
feeling. ' '  Here  the  inaccuracy  of  the  concept  ' '  feeling  ' '  is 
well  shown.  Is  there  a  "feeling  of  being  persecuted  ",  if 
one  regards  feeling  as  a  part  of  affectivity  as  Specht  has  ex- 
pressly done?  In  the  case  in  hand  the  word  designates  an 
"intellectual  feeling"  (Nahlowsky),  a  purely  intellectual 
or,  according  to  others,  an  "objective"  process.  I  can 
know  that  I  am  persecuted,  I  can  suppose  it,  I  can  feel  it, 
i.  e.  conclude  it  in  an  indefinite  fashion  from  various  occur- 
rences. All  these  are  intellectual  processes  but  naturally, 
as  in  the  case  of  the  majority  of  other  intellectual  processes, 
they  are  accompanied  by  "  feelings  "  in  the  sense  of  affects. 
The  correctness  of  our  conception  is  shown  in  a  striking 
manner  when  Specht  further  says  that  there  are  things 
which  one  can  feel  but  not  prove.  What  has  such  a 
feeling  to  do  with  affectivitv  ? 


78 

Pages  25-26.  If  the  "  bellicose  delusion  of  persecution  is  conquered 
over  night  by  the  faint-hearted  idea  of  sin  or  injury  "  it  is  no  proof 
for  the  fundamental  nature  of  the  emotional  disorder  in  paranoia.  A 
normal  person,  continually  persecuted,  is  seldom  permanently  free 
from  faint-hearted  moods.  Therefore,  I  also  fail  to  see  why  an  idea 
■should  be  more  capable  of  resistance  if  it  is  the  product  of  a  primarily 
disturbed  intellectual  activity. 

Page  27.  "  The  paranoic  affect  as  a  mixed  affect  lacks  the  evident 
effect  upon  the  behavior  of  the  patient. ' '  According  to  Specht,  page 
18,  defiance,  anger,  quarrelsome  exaltation,  are  also  mixed  affects. 
Nevertheless  these  are  associated  with  very  distinct  modes  of  ex- 
pression. The  mixed  nature  of  the  paranoic  affect  would  therefore 
not  explain  such  an  absence  of  effect  upon  the  behavior  even  if  sus- 
piciousness were  an  affect. 

If  this  affect  of  suspiciousness  is  not  noticed  because  it  is  so  fre- 
quent in  normal  men,  then  moderate  degrees  of  exalted  and  depressed 
moods  must  not  be  noticed  because  they  are  still  more  frequent.  "We 
notice  them,  however,  even  in  the  absence  of  tears  and  we  consider 
them  pathological  when  they  are  no  longer  adequate  to  the  circum- 
stances. 

Page  30.  From  the  prevailing  notion  of  paranoia  Specht  draws  the 
conclusion  that  the  criminal  judge  can  hold  the  patient  unaccountable 
for  his  acts,  if,  for  example,  it  is  a  question  of  a  false  accusation  on 
the  basis  of  insane  ideas,  but  not  if  the  paranoic  has  killed  his  alleged 
opponent.  He  claims  that  if  there  existed  no  (general)  emotional 
disorder  and  only  a  (partial)  intellectual  disorder  the  crime  would 
only  in  the  first  case  be  dependent  on  the  disease.  Without  referring 
to  other  reasons  for  objection  I  would  only  like  to  call  attention  to 
the  fact  that  the  disposition  which  could  lead  to  merely  an  intel- 
lectual disorder  might  just  as  well  be  general  as  the  emotional  dis- 
order which  Specht  assumes.  On  account  of  this  objection,  therefore, 
we  would  not  have  to  change  our  medical  testimonies  in  court. 

Let  us  in  conclusion  say  something-  of  the  limitation  and 
uniformity  of  delusions  of  persecution  and  grandeur.  Specht 
explains  this  by  saying  that  the  underlying  feeling  has 
only  two  fundamental  qualities,  those  of  pleasure  and  dis- 
pleasure. This  would  only  be  correct  if  all  feelings  could 
be  aligned  between  pleasure  and  displeasure.  This,  how- 
ever, is  open  to  question.  For  this  reason  the  fact  that 
('page  18)  defiance,  anger,  discontent,  quarrelsome  exalta- 
tion, can  not  be  classed  in  the  two  categories  of  pleasure 
and  displeasure  does  not  mean  that  they  represent  a  mix- 
ture of  pleasure  and  displeasure.  They  may  also  be  some- 
thing  entirely  different.      Moreover,   if   there    are    several 


79 

mixed  affects  why  should  there  be  only  one  psychosis  which 
corresponds  to  the  mixed  affect  of  suspiciousness,  why  is 
there  not  an  anger  psychosis  and  a  quarrelsome  exaltation 
psychosis  ? 

That  only  mania  and  melancholia  play  a  part  in  the 
(acute  )  affect-psychoses  is  easily  understood.  Pleasure  and 
displeasure  are  the  simplest  affects  so  far  as  their  dependence 
on  our  bodily  condition  is  concerned.  We  can  easily  con- 
ceive that  these  general  affects  correspond  to  a  definite 
bodily  condition.  The  special  and  more  complicated  affects, 
however,  can  not  have  such  a  general  cause,  just  as  we  can 
not  conceive  a  pathological  stimulation  of  the  acusticus 
which  causes  us  to  hear  words,  while  in  this  manner  simple 
sounds   and  inco-ordinated  noises  are  aroused  every  day. 

We  shall  later  give  a  preliminary  explanation  of  the 
types  of  delusions  of  paranoia.  The  above  are  the  most 
important  objections  to  Specht's  view.  I  would  like  here 
to  refer  to  the  fact  that  Storring*  has  never  been  able  to 
note  that  ideas  of  being  observed  or  ideas  of  reference  pre- 
ceded ideas  of  persecution,  and  that  he  observed  delusions 
of  persecution  in  a  number  of  cases  where  there  certainly 
were  no  delusions  of  reference  present. 


We  must  now  consider  the  common  view,  that  the  cause 
of  paranoia  is  due  to  some  sort  of  hypertrophy  of  the  ego. 
This  is  easily  demonstrated  in  the  well-developed  disease  if 
one  comprehends  the  idea  somewhat  broadly.  It  is  self- 
evident  in  all  forms  of  gradiose  delusions.  In  the  delusions 
of  persecution  some  deduction  is  necessary  to  demonstrate  it. 
A  person  who  sees  a  large  number  of  opponents  against  him, 
who  knows  that  some  one  is  making  almost  unbelievable 
efforts  to  harm  him  must,  so  one  says,  logically  conclude  that 
he  is  worthy  of  such  efforts.  This  is  supposed  to  explain  the 
so-called  transformation  of  delusions  of  persecution  into 
delusions  of  grandeur.  About  the  existence  of  this  trans- 
formation I  can  not  help  being  sceptical.     Many  paranoics 

*  Psyclioftathologie,  Leipzig^  /goo. 


80 

do  not  draw  this  conclusion  and  their  logic  fails  if  one  would 
have  them  do  it,  just  as  it  does  when  one  tries  to  show  them  the 
foolishness  of  their  delusions  (compare  Case  l).  An  hyper- 
trophy of  the  ego  in  the  above  sense  is  therefore  not  a 
regular  occurrence  in  paranoia.  It  is  further  said  that  the 
delusions  of  reference  point  to  the  fact  that  the  ego  has 
niore  associations  than  normally  so  that  a  great  mass  of  ex- 
periences, which  otherwise  would  be  unnoticed  or  remain 
in  other  connections,  are  connected  with  the  ego  complex. 
This  also  is  not  a  gradiose  tendency  nor  any  other  sort  of 
pushing  forward  of  the  ego,  for  when  such  a  complex, 
from  associative  reasons  (constellation)  or  from  emotive 
reasons,  comes  into  the  foreground  and  is  almost  continu- 
ally present  in  the  mind  it  is  naturally  associated  with 
everything.  Moreover,  without  this  kind  of  "self-over- 
valuation" a  delusion  of  reference  is  not  possible.  Hence 
to  postulate  it  means  begging  the  question. 

In  the  Psychiatrische  Wochenschrift,  1901-02,  page  255,  I  have  said 
that  not  even  the  broader  conception  of  the  pathological  ideas  of 
reference  suffices  to  explain  the  megalomanic  forms.*  Tiling  (loc. 
cit.  page  434)  thinks  that  I  have  overlooked  the  fact  that  normal  as 
well  as  abnormal  people  are  not  cold-blooded  at  the  conception  of  an 
important  idea  but  that  there  goes  with  it  some  affect  of  pride  or  of 
love.  I  am  of  course  aware  of  this,  but  I  think  that  when  a  normal 
person  conceives  such  an  idea  and  has  with  it  a  feeling  of  pride,  he 
does  not  necessarily  have  an  hypertrophied  ego  and  therefore  there 
is  no  reason  to  assume  this  when  a  person  gets  such  an  idea  by 
means  of  false  instead  of  correct  reasoning.  If  the  ego  is  really 
hypertrophied  or  too  much  emphasized  by  feelings  this  would  have 
to  show  itself  in  other  ways  as  well.  I  gave  as  example  the  persons 
who  constantly  push  forward  their  own  personalities  and  their  own 
names,  which  fact  in  general,  not  in  every  individual  case,  gives  a 
certain  index  of  the  role  which  the  ego-complexj)lays  in  the  thoughts 
of  the  individual.  Tiling  therefore  seems  to  me  to  be  wrong  when  he 
says  :  ' '  whether  the  '  ego '  expressly  appears  or  not  is  a  matter  of 
indifference,  all  the  fibers  of  the  emotional  life  are  concerned  in  the 
idea."  I  should  like  to  see  a  mental  product  in  which  all  the  fibers 
of  the  emotional  life  are  concerned  and  in  which  there  does  not  exist 
a  subjective  coloring  in  the  sense  of  pushing  to  the  foreground  the 
ego.  Hence  we  can  not  admit  the  primary  significance  of  the  hyper- 
trophy of  the  ego  for  the  origin  of  paranoia,  because  we  frequently 
find   a   special   emphasis   of   the   ego   only   when   this    is   naturally 

*Specht  also  writes,  p.  n,  "The  paranoic  delusion,  especially  the  delusion  of 
grandeur,  can  come  into  existence  without  any  peculiar  feeling  of  reference." 


81 

expected,  and  when  it  would  be  seen  under  the  same  conditions  in 
normal  individuals  as  well ;  while  there  are  many  non-paranoics 
who  suffer  from  such  an  hypertrophy. 

For  similar  reasons  we  must  reject  the  views  of  Berze* 
which  really  only  condense  and  make  more  precise  what 
many  others  have  already  supposed.  He  says  that  the 
psychopathological  foundation  of  paranoia  is  a  derange- 
ment of  the  apperception,  i.  e.,  a  difficulty  of  raising  a 
mental  content  into  the  focus  of  attention.  This  derange- 
ment causes  a  feeling  of  passivity  like  passive  apperception 
and  interferes  with  subsequent  apperceptions  which  would 
readily  follow  in  the  normal. f 

This  conception  is  wrong  because  only  a  very  small  part 
of  the  perceptions  is  changed.  Even  in  a  marked  case 
many  thousands  of  normal  apperceptions  occur  to  one 
which  is,  in  the  paranoic  sense,  falsified.  It  is  also  not  true 
that  to  the  paranoic  everything  seems  different  than  for- 
merly, as  many,  who  assume  a  primary  emotional  disorder, 
would  maintain.  Naturally  much  must  appear  different 
because  it  is  perceived  in  a  different  relation.  Every 
normal  person  may  observe  that  in  himself.  In  the  picture 
"where  is  the  cat "  we  see  the  cat  or  the  tree,  each  accord- 

*  Das  Primarsymptom  der  Paranoia,  Halle,  Marhold,  igoj. 

tThe  change  in  the  appearance  of  the  environment  that  is  frequently  claimed 
to  exist  in  the  beginning  of  paranoia,  I  have  not  as  yet  seen  in  a  paranoic.  On 
the  other  hand  it  is  not  at  all  uncommon  in  the  different  forms  of  dementia 
prascox.  I  can  therefore  not  repress  the  thought  that  the  cases  where  the 
symptom  is  not  produced  secondarily  by  the  affective  or  intellectual  disorder  of 
paranoia,  belong  to  the  paranoid  form  of  dementia  prsecox.  All  my  experi- 
ence is  opposed  to  the  assertion  that  the  paranoic  apprehends  everything  in 
a  changed  manner.  (Tiling  Individnelle  Geistesartung,  Wiesbaden,  1Q04,  p.  242). 
I  have  also  not  been  able  to  see  that  the  "  Kern  des  Individuunis  "  (the  center  of 
personality)  is  changed  (Tiling,  p.  43).  Moreover,  such  an  observation,  in  spite 
of  the  statements  of  Tiling,  would  hardly  be  in  accord  with  his  endeavor  to 
derive  paranoia,  especially  the  originary  paranoia  directly  from  the  mental 
makeup  of  the  individual.  It  would  be  of  the  highest  theoretical  importance  if 
one  could  demonstrate  the  general  derangement  of  the  mind  or  of  the  brain  in 
paranoia.  As  yet  only  a  partial  derangement  is  perceivable  to  which  the  other, 
striking,  symptoms  are  secondarj^,  but  normal,  reactions. 

In  some  cases  of  affect-ps3'choses,  especially  in  melancholia,  the  patient  some- 
times declares  that  everything  seems  changed.  A  very  intelligent  teacher, 
after  recovery,  told  me  that  everything  seemed  to  be  covered  with  a  grey  ash, 
although  she  recognized  the  colors  quite  well.  I  have  noticed  the  same 
symptom  in  myself  for  a  few  minutes  in  a  normal  depressive  affect.  I  can  not 
better  describe  it  than  above,  although  that  description  does  not  cover  the  con- 
dition exactly. 


82 

ing  to  whether  the  attention  is  focused  on  the  tree  or  on  the 
cat.  One  can  conceive  in  different  waj^s,  geometrical 
figures,  especially  if  they  consist  of  points.  Orders  which 
we  have  given  under  certain  conditions  often  appear  in 
other  connections  as  something  entirely  different  so  that  we 
do  not  recognize  them  when  they  are  mentioned  in  such 
connection.  Here  it  is  always  a.  matter  of  constellations, 
of  associations,  and,  as  I  will  here  emphasize,  this  may  not 
only  have  affective  but  may  just  as  well  have  purely  intel- 
lectual reasons. 

It  is  easily  understood  that  much  in  the  new  affective  and 
intellectual  relations  must  appear  very  different  than  for- 
merly.    That  all  appears  different  is  incorrect. 

The  circumstance  that  the  formation  of  a  paranoic 
delusion  takes  time  is  another  reason  why  it  is  difficult  to 
accept  a  primary  perceptive  disorder  in  paranoia.  Unfor- 
tunately I  have  insufficiently  recorded  my  observations  in 
this  regard,  but  as  far  as  I  remember  all  the  many  cases, 
which  formed  a  delusion  and  the  corresponding  reaction 
immediately  from  a  word  or  perception,  belong  to  dementia 
praeeox.  In  Kraepelin's  paranoia  I  can  recall  only  a  more 
gradual  formation  of  delusions.  When  Case  I  comes  from 
church  she  often  does  not  think  that  the  preacher  has  said 
anything  about  her  this  time.  But  frequently  the  delusion 
then  arises  in  the  night  or  sometimes  only  after  several  days.* 
An  incubation  of  several  hours  is  generally  observed. 
We  find  the  same  thing  in  the  origin  of  traumatic  hysteria. 

The  view  of  Linke  is  also  refuted  by  this  presentation. 
Linke  (Allgem.  Zeitschrift  f.  Psych.  1897,  p.  567)  saj^s: 
"The  underlying  cause  of  the  delusions  in  primary- 
paranoia  is  the  increase  in  intensity  of  perceptions  which  is 
determined  by  the  pathological  affect  conditions  (expectant 
attention)".  According  to  Linke  the  ideas  of  self-abase- 
ment correspond  to  depression,  the  ideas  of  grandeur  to 
euphoria  and  the  ideas  of  being  observed  to  expectant 
attention. 

*I  have  seen  a  paranoic  who  only  formed  her  delusions  from  paramnesias. 
The  illusions  of  memory  occurred  usually  a  long  time,  up  to  a  year,  after  the 
given  occurrence. 


83 

For  similar  reasons  the  view  that  the  change  in  the 
memory  pictures  (Wernicke)  give  occasion  for  the  formation 
of  delusions  must  be  rejected.  Of  millions  of  memory- 
pictures,  even  in  the  most  marked  cases  of  paranoia,  only 
a  very  few  are  really  falsified,  namely,  those  which  are 
brought  into  relation  with  the  delusions.  This  selection  is 
analogous  to  the  predominating  falsifications  of  memory 
of  normal  persons  who  recast  the  memory-pictures  accord- 
ing to  their  desires.  The  illusions  of  memory  *  are  certainly 
secondary  and  not  the  cause  of  the  disorder. 


The  observation  of  paranoia  shows  another  connection  of 
the  delusion  with  the  affects,  which,  so  far  as  I  know,  has 
not  been  sufficiently  considered.  It  may  be  illustrated  by 
histories  of  a  number  of  cases. 

Case  1.  Female,  single,  protestant,  born  1853.  The  only  living- 
brother  of  the  patient  is  very  frivolous  and  a  moderate  drinker. 
Otherwise  as  far  as  is  known  there  is  no  psychoneirrotic  heredity. 

The  patient  until  the  outbreak  of  paranoia  was  mental^  and  phys- 
ically normal,  cheerful,  not  eccentric.  Always  respectable,  indus- 
trious, orderly.  According  to  one  report  she  was  headstrong  and 
easily  excited.  The  latter  was  corroborated  by  the  patient.  This  trait 
is  not  especially  marked  now.  She  got  along  well  in  school  and 
attended  the  secondary  school  for  two  years.  Before  she  left  school  her 
father,  on  account  of  severe  lead-poisoning,  had  to  give  up  his  occu- 
pation as  a  painter  and  took  up  a  delicatessen  shop.  The  father  died 
some  two  years  after  he  had  been  in  the  shop]  (in  1S70)  which,  although 
it  had  gone  fairly  well,  came  into  bankruptcy.  The  mother  recovered 
her  dowery.  An  uncle  of  the  patient,  husband  of  her  father's  sister, 
who  was  well  situated,  had  taken  over  the  shop  and  had  advanced 
money  for  it,  shortly  before  the  death  of  the  patient's  father.  The 
patient  was  bound  over,  by  the  contract  of  sale,  to  manage  the  shop. 
Some  two  years  afterward  she  relinquished  the  situation.  The  reason 
for  her  so  doing  is  the  single  unclear  point  in  her  life.  She  remem- 
bers that  she  gave  notice  and  that  the  uncle  gave  the  shop  over  to  his 
housekeeper  who  later  became  his  second  wife.  She  then  went  as  a 
maid  to  a  nature-cure  establishment  where  she  remained  a  year  but 
she  had  a  feeling  that  the  cure  was  a  fraud.     A  patient  there  procured 

♦Unfortunately  owing  to  the  scarcity  of  paranoics  in  hospitals  we  have  not 
succeeded  in  analyzing  a  case  according  to  Freud  s  methods.  The  case  in  the 
Neurol.  Centralbl.  1894,  is  undoubtedly  one  of  dementia  prsecox.  In  the  latter 
disease  the  demonstration  of  Freud's  mechanism  is  very  easy. 


84 

for  her  a  situation  as  a  nurse  girl  in  French  Switzerland,  ' '  because  I 
always  had  an  idea  at  that  time  of  learning  languages  or  something 
else  that  was  useful. "  She  prospered  there  but  after  a  year  and  a  half 
had  to  return  home  on  account  of  a  severe  illness  of  her  mother. 

After  the  recovery  of  her  mother  she  was  occupied  with  making 
copies  in  a  recorder's  office  but  the  income  was  small  and  irregular. 
The  same  friend  who  had  procured  for  her  this  work  secured  for  her 
a  position  of  trust  in  a  goldsmith's  shop  (1875),  where  she  was  book- 
keeper and  had  control  of  the  workers  in  silver  and  the  incoming 
and  outgoing  of  the  silver,  especially  of  the  waste.  She  was  there 
three  years  when  her  uncle  again  called  her  to  his  shop  on  account  of 
the  death  of  his  second  wife,  1878.  At  the  same  time  his  son  came 
into  the  business  and  house.  The  father  and  son  had  children  of  the 
same  age  and  there  was  often  trouble  in  the  family.  Both  parties  told 
the  patient  their  troubles  which  naturally  was  very  disagreeable  for 
her.  "I  was  always  between  the  hammer  and  the  anvil."  She  also> 
probably  thought  that  the  conflicting  parties  would  hold  her  respon- 
sible for  the  bitterness  of  the  relations,  as  a  normal  person  might  also  ■ 
think.  In  1881  she  went  to  her  mother  and  supported  herself  by 
making  cream  bonbons  and  Hilpen,  a  special  kind  of  Zurich  pastry. 
The  two  women  were  always  overwhelmed  with  orders  and  over- 
exerted themselves  with  the  work  which  required  much  care  and  also 
made  large  demands  on  their  physical  energy. 

In  1888  a  peddler  who  had  taken  most  of  the  Hi'ipen  became  ill. 
The  patient  began  to  complain  that  if  the  peddler  died  she  could  not 
dispose  of  her  goods.  She  made  various  plans  how  she  could  help 
herself  but  she  had  to  discard  them.  At  the  same  time  the  idea  came 
to  her  that  certain  people  would  not  be  sorry  if  she  could  not  make 
both  ends  meet.  Afer  a  few  weeks  the  peddler  recovered  and 
every  thing  went  on  as  before,  and  she  also  corrected  every  fear 
and  the  beginning  idea's  of  persecution.  In  1889  the  peddler  died 
rather  suddenly.  The  distress  began  anew  and  indeed  was  intensi- 
fied. She  thought  that  in  order  to  procure  a  sure  means  of  existence  - 
she  would  take  up  a  branch  of  a  provision  business.  Through  the 
help  of  her  uncle  she  was  able  to  do  this  and  signed  the  contract. 
While  she  was  signing  the  contract,  however,  the  doubt  came  to  her 
whether  she  could  succeed  in  this  business,  and  on  the  next  day  she 
cancelled  the  contract. 

The  disease  now  begins.  .  Ruin  seemed  certain  to  her.  She  felt  she 
did  not  earn  what  she  ate.  She  reproached  herself  because  she  her- 
self had  not  peddled  her  goods  although  this  would  have  been  impossi- 
ble, and  the  shop  was  doing  well.  According  to  her  idea  the  customers 
who  came  into  the  shop  did  it  only  for  show,  really  they  would 
soon  stop  purchasing  anything  from  her.  She  became  more  exact  in 
the  preparation  of  the  goods  and  reproved  her  mother  if  she  was  less 
exact,  while  formerly  she  had  always  followed  the  latter's  direction. 
She  must  have  been  conscious  of  this  because  she  heard  a  neighbor 


85 

■say  once,  "if  I  had  such  a  child  I  would  give  it  a  rawhide  and  would 
not  give  it  anything  to  eat, ' '  and  referred  it  to  herself.  The  logic 
Avith  which  she  proved  this  to  be  correct  is  characteristic.  She  had 
certainly  been  rude  to  her  mother.  The  house  was  permeable  to 
sound.  The  man  was  a  drinker  and  always  made  such  coarse 
speeches.  The  first  reason  is  in  truth  only  a  probability  that  she  was 
meant.  The  others  are  proofs  for  the  possibility  that  the  man  had  so 
spoken  that  she  would  hear  it.  For  the  patient  this  is  a  certain  chain 
of  conclusions  that  she  was  meant. 

She  heard  many  people  speaking  about  her.  One  said  that  she 
must  yet  go  begging.  Then  some  one  criticized  her  actions  and  made 
remarks  such  as,  "  now  she  does  this  or  that. "  Once  when  she  was 
sewing,  a  physician,  who  had  been  called  without  her  knowledge, 
came  to  see  her.  Then  she  heard  the  janitor  say,  "now  she  sews, 
•usually  she  does  nothing. ' ' 

x\t  this  time  the  most  important  thing,  according  to  the  patient's 
account,  is  that  she  heard  the  landlord  say  on  one  occasion  that  he 
had  thought  there  would  come  a  time  when  they  would  take  revenge 
on  her.  She  immediately  thought  of  her  uncles  and  cousins  who  had 
something  to  pay  her  back.  Formerly  she  had  never  thought  that 
these  people  could  have  anything  against  her,  excepting  the  indefin- 
ite thought  that  she  was  partly  responsible  for  the  trouble  between 
them. 

The  patient  states  that  she  has  never  had  hallucinations,  and  she 
knows  exactly  what  is  meant  by  that.  Everything  has  been  said 
under  circumstances  where  it  was  possible  that  some  one  spoke  and 
with  a  natural  localization.  Nevertheless  the  above  related  occurrences, 
but  only  these,  arouse  the  suspicion  of  hallucinations  or  illusions.' 
Later,  and  also  in  the  asylum,  where  for  years  all  her  delusions  were 
subjectively  and  objectively  analyzed,  no  trace  of  hallucinations  ivere 
found.  To  be  sure  the  patient  often  related  something  which  appar- 
ently could  only  be  an  hallucination.  But  if  we  requested  a  more 
accurate  wording,  which  we  could  always  secure  if  we  had  patience 
enough,  or  if  we  determined  objectively  what  was  spoken,  without 
exception  it  was  shown  that  we  were  dealing  with  a  false  interpreta- 
tion in  the  sense  of  self-reference.  Bui  it  is  very  hard  for  the  patient 
to  speak  or  think  of  the  zvords  she  has  misinterpreted  without  self- 
reference.  She  thinks  she  is  giving  an  accurate  account  in  relating 
that  the  preacher  said  that  she  was  going  to  be  miserable,  when  really 
he  had  only  spoken  of  misery  in  a  general  way.  It  requires  a  very 
energetic  request  to  get  her  to  give  the  real  wording  and  even  then 
she  reproduces  it  a  few  seconds  later  in  the  way  corresponding  to 
the  delusion.  A  deliberate  luisrepresentation  is,  without  any  doubt, 
■  excluded  owing  to  her  truthfulness  and  her  interest  in  the  psycho- 
logical analysis.  It  is  remarkable  that,  at  least  during  her  present 
admission  to  Burgholzli,  all  self-references  are  not  made  immediately 
after  the  critical  occurrence  but  only  after  several  hours,  very  often 


86 

only  on  the  following  day  or  even  later.  The  delusion  of  reference- 
requires  a  certain  incubation  time  for  its  development.  Further  it 
may  be  important  that  it  has  never  happened  that  a  real  reproof  has 
been  interpreted  erroneously.  And  occasions  are  not  lacking,  for  in 
spite  of  her  capability  and  conscientiousness  the  complexity  of  her 
tasks  and  her  frequent  distractions  on  account  of  her  delusions,  cause 
her,  now  and  then,  to  make  mistakes.  She  always  accepts  the  re- 
proofs with  a  ready  comprehension  and  modesty.  She  always  con- 
nects her  delusions  to  things  which  are  indifferent  to  a  normal 
person.  When  she  is  reproved  for  some  real  mistake  the  thoughts  and 
feelings  are  directed  by  the  circumstance,  but  in  indifferent  speeches 
the  individuality  has  a  freer  hand.  Perhaps  the  explanation  of  this 
remarkable  fact  lies  in  this  difference. 

About  the  end  of  1890  the  preacher  in  one  of  his  sermons  said 
"whom  God  has  helped  in  the  past,  will  He  also  help  in  the  future." 
In  this  sermon  she  heard  only  the  first  part.  ' '  Whom  God  has 
helped  in  the  past."  She  referred  these  words  to  herself :  God  would 
not  help  her  in  the  future.  From  this  time  on  she  heard  continual 
reference  to  her  future  misery  in  the  sermons  of  the  different 
preachers. 

In  order  to  be  away  from  home  she  went  one  time  to  a  friend  whom 
she  helped  in  the  housework.  When  she  worked  in  the  kitchen  she 
thought  that  some  one  watched  her  from  the  other  room  through  a 
hole  behind  a  bookcase.  After  it  was  proven  to  her  that  there  was 
no  hole  there  she  thought  of  another  way,  a  mirror  for  example,  by 
means  of  which  some  one  could  watch  her.  A  baker  had  burned  a 
cake  which  had  been  given  him  to  bake,  and  she  thought  that  he  had 
done  it  to  show  her  that  she  was  not  doing  right.  (These  ideas  she 
now  corrects) . 

In  the  summer  of  1891  she  went  to  Darmstadt  with  an  acquaintance 
who  was  going  to  introduce  a  manufactory  of  the  kind  of  pastry  she 
used  to  make.  But  after  a  few  weeks  she  had  to  return.  She  was  not 
able  to  work  well  and  the  people  followed  her  with  slanderous 
reports,  more  than  formerly,  all  of  which  referred  to  her  ruin  and  to 
the  fact  that  she  could  expect  no  more  help.  At  home  she  thought 
she  could  work  better  with  her  usual  utensils  but  she  had  deceived 
herself.  She  could  do  almost  nothing.  She  said  herself  that  she 
was  scarcely  able  to  knit.  She  had  already  expressed  the  idea  of 
suicide. 

She  was  brought  to  Burgholzli  August  18,  1891,  with  the  diagnosis  : 
Melancholia.  Here  her  complaints  were  the  same  as  outside  and  she 
desired  to  go  away.  There  was  nothing  for  her  to  do  here.  They 
had  told  her  that  she  would  be  able  to  work  here  and  therefore 
she  had  brought  a  lot  of  old  clothing  with  her  to  mend.  Now 
they  made  fun  of  her  because  she  had  brought  the  old  clothes 
with  her.  They  watched  her  secretly.  It  was  foolish  to  keep  her 
locked  up  in  a  place  where  she  needed  money  and  earned  none.     She 


87 

suffered  the  more  because  she  saw  that  she  was  being  observed. 
Every  one  knew  all  of  her  doings  and  luade  fun  of  her  because  she  was 
loafing  and  earning  no  money. 

In  the  latter  part  of  1891  and  the  beginning  of  1892  she  received 
from  her  cousin  some  writing  to  be  done  in  the  institution.  She  did 
it  very  well,  but  was  not  content  because  she  thought  she  was  paid 
more  than  her  work  was  worth  and  that  she  should  therefore  not 
accept  the  money.  On  the  other  hand  she  occasionally  also  com- 
plained of  her  relatives  and  said  they  were  not  helping  her  as  they 
had  promised.  She  frequently  wept  over  her  condition,  especially 
over  the  fate  of  her  mother  who  could  not  support  herself.  From  the 
beginning  of  her  stay  in  the  institution  she  had  worked  industriously 
and  she  was  orderly  in  her  behavior.  When  there  was  a  question  of 
her  release  she  requested  that  her  cousin  find  her  a  place,  then  she 
thought  she  could  not  accept  it  but  must  remain  with  her  mother. 
On  February  9,  1892,  she  was  discharged  as  improved  to  her  mother 
with  a  diagnosis  of  paranoia.  In  spite  of  the  fact  that  her  mother 
told  her  that  she  had  more  orders  than  she  could  fill  she  did  not  dare 
to  take  up  her  former  work.  She  thought  that  the  orders  would  only 
continue  until  she  came  home  and  would  then  cease.  After  some 
time  she  was  more  certain  of  herself,  but  nevertheless  she  sought 
several  customers  before  she  would  again  take  up  the  work  of  pastry 
making. 

The  disease,  however,  was  not  cured.  Every  one  gave  her  to 
understand  that  she  could  earn  no  more  and  that  she  would  yet  have 
to  go  to  the  poorhouse.  The  preacher  especially  continually  made 
such  allusions.  The  idea  of  suicide  became  more  prominent  and 
only  the  thought  of  her  mother  restrained  her.  In  February,  1895' 
she  tried  to  freeze  herself.  Then  she  was  in  a  private  institution  for 
several  weeks  and  was  discharged  improved.  After  this  she  luade  an 
attempt  to  drown  herself,  but  desisted  in  time.  The  next  two  weeks 
were  comparatively  quiet.  The  patient  could  work  but  often  told  her 
acquaintances  that  she  was  in  a  bad  condition  financially  and  some- 
times asked  for  their  help,  although  in  reality  the  business  was  pros- 
pering. She  gradually  grew  worse  and  accused  other  people,  espe- 
cially her  uncle  and  his  son,  of  being  the  cause  of  her  misfortune. 
Generally,  however,  she  threw  all  the  guilt  on  herself. 

One  morning  she  poured  petroleum  over  herself  and  set  fire  to  it. 
When  she  was  ablaze  she  cried  for  help  and  was  rescued  after  receiv- 
ing some  severe  burns.  In  the  hospital  nothing  was  noticed  except 
that  she  presented  a  somewhat  unstable  but  rather  depressed  mood 
and  that  she  referred  many  harmless  observations  of  her  neighbors 
to  herself,  in  the  same  way  as  formerly.  When  the  wounds  were 
nearly  healed  she  came  to  Burgholzli  on  the  16th  of  December,  1898. 

Here  she  behaved  in  an  orderly  manner.  She  worked  industriously 
from  the  beginning  but  held  to  her  ideas  unchanged,  which  even 
though  they  did  recede  at  times,  soon  came  into  the  foreground  again. 


88 

Besides  taking  care  of  all  possible  affairs  in  the  house  the  patient 
began  to  copy  medico-legal  opinions  in  an  exemplary  way,  later  she 
was  charged  with  the  care  of  the  copying,  registration  and  similar 
affairs  in  the  physicians'  office  and  became  almost  indispensable.  For 
two  years  she  was  my  private  secretary  and  took  care  of  my  associa- 
tion business  and  several  accounts.  Every  thing  went  along  excel- 
lently except  when  she  had  been  to  church  or  had  made  a  visit  to  her 
home,  or  when  in  other  ways  she  was  more  occupied  with  her 
delusions,  she  made  some  mistakes  which  she  strove  to  correct. 
Finally  it  happened  that  some  of  my  relatives  became  connected  with 
her  system  of  delusions  and  after  that  she  was  constantly  stirred  up. 
She  now,  with  short  interruptions,  does  very  well  on  the  wards  and  in 
the  office;  she  has  the  keys  and  enjoys  more  trust  than  many 
employees. 

Even  if  now  and  then  she  sees  that  she  erred  in  her  delusions  of 
reference  she  holds  to  her  system  of  delusions.  She  thinks  that  her 
uncle  and  cousins  consider  her  partly  accountable  for  the  family 
quarrel,  that  through  her  indecision  she  was  the  cause  of  the  poor 
business  after  the  death  of  the  peddler.  The  cousins  seized  this 
moment  to  take  revenge  on  her.  Others  thought  evil  of  her  and  took 
joy  in  her  ruin.  All  these  enemies  had  formed  a  league.  They  had 
informed  the  preacher  in  every  place  where  she  went  to  church  so 
that  he  could  always  say  something  in  his  sermon  which  was  meant 
for  her,  and  tell  her  how  unfortunate  she  will  be  or  how  she  had 
neglected  this  or  that  thing  which  could  have  helped  her.  Even  in 
the  institution  the  director  and  physicians  were  in  league  with  her 
persecutors.  I,  for  example,  alwa)^s  informed  the  preacher  and  other 
enemies,  by  letter  or  by  telephone  and  telegraph,  when  she  went  to 
church.  I  also  informed  the  nursing  force  of  every  thing  she  did,  so 
that  the}'  made,  indirectly,  scornful  and  blameful  remarks.  I  do  not 
belong  to  her  particular  enemies  but  I  will  punish  her  because  she 
had  made  so  many  mistakes,  and  she  deserves  this  punishment.  To 
be  sure  I  have  often  promised  her  that  I  would  help  her  all  I  could, 
but  it  would  be  easy  for  me  to  procure  her  a  position  in  which  at 
least  she  could  earn  her  living,  but  now  it  is  too  late;  she  has  thrown 
my  help  away  and  she  is  not  worthy  of  it. 

So  far  as  the  delusions  are  not  concerned,  or  when  they  are  more  in 
the  background,  her  emotional  state  is  a  perfectly  normal  one.  Joy 
in  beautiful  things,  love  for  her  mother,  gratefulness  (even  towards 
me  |  are  preserved.  The  intelligence  is  above  trie  average.  She  pre- 
serves interest  in  other  things  ;  she  makes  diagnoses,  comdemns  the 
idea  of  dementia  praecox  because  it  is  too  broad,  etc.  She  is,  except 
for  the  delusions,  and  partly  also  with  them,  more  unassuming  than 
many  normal  persons.  She  underestimates  her  work.  Comprehen- 
sion, apperception,  is  normal  in  every  way.  Things,  situations  are  no 
different  to  her  than  before  the  beginning  of  her  illness.  Only  in 
her    delusions  does  she  show  anything  that  could  be  so  conceived. 


89 

But,  according  to  the  self-observation  of  the  patient,  this  does  not  cor- 
rectly express  it  as  contrasted  to  her  former  condition.  And  I  lay 
great  stress  on  her  introspection.  For  in  spite  of  all  the  patient  has 
retained  a  great  objectivity  in  regard  to  her  disease.  She  knows 
very  well  that  we  regard  her  ideas  a's  morbid,  and  one  can  talk  to  her 
about  her  delusions  as  one  could  to  a  third  person.  In  her  relatively 
good  periods  she  considers  herself  insane  and  recognizes  in  principle 
that  her  ideas  of  reference  are  pathological,  although  in  specific  in- 
stances, which  are  the  most  important  at  the  time,  she  persists  in  the 
correctness  of  her  interpretation  or,  as  she  thinks,  her  observations. 
She  may  also  calmly  state  that  she  has  corrected  this  or  that  idea.  If 
one  calls  attention  to  the  fact  that  the  present  delusions  are  exactly 
the  same  she  may  say  that  they  are  yet  too  fresh  but  that  perhaps  in  a 
few  years  it  will  be  possible  for  her  to  see  the  matter  in  a  different 
light.  Nevertheless  she  discusses  the  paranoia  of  others  and  tries  to 
prove  to  me  that  her  case  is  entirely  different  because  her  ideas  are 
based  on  facts.  If  I  ask  her  what  reason  she  has  to  think  I  would  take 
so  much  troiible  to  injure  her  when  no  one  is  better  able  than  she  to 
appreciate  how  I  must  take  care  of  my  time  and  money,  this  makes  no 
impression,  although  she  can  not  give  me  any  plausible  grounds.  It 
is  just  as  she  says,  I  wish  to  punish  her.  She  needs  no  further  reasons. 
The  objection  that  I  can  not  act  as  she  thinks  I  do  does  not  exist  for  her. 
There  is  no  delusion  of  grandeur  behind  these  unreasonable  imputa- 
tions which  she  ascribes  to  me,  and  she  does  not  draw  "the  conclusions 
which  might  be  regarded  as  grandiose  ideas  and  which  to  the  normal 
might  seem  natural  consequences  of  such  a  situation. 

As  an  illustration  of  how  far  the  ideas  of  reference  go  with  this 
patient  I  will  give  some  other  examples, 

In  the  beginning  of  her  illness  the  preacher  said  in  a  sermon  :  ' '  since 
New  Year  the  idea  has  not  left  me  '  plow  anew,  do  not  sow  under  the 
thorns'  ".  Soon  after,  in  a  carnival  celebration,  the  picture  of  the 
jumping  pig  was  displayed  with  the  label  "Debut  of  the  celebrated 
equestrienne,  Miss  Thome. ' '  She  was  certain  that  the  people  had  un- 
derstood the  allusion  of  the  preacher.  The  pig  is  an  allusion  to  the 
fact  that  she  is  untidy. 

The  supervisor  comes  into  the  office  whistling.  Delusion :  the 
Director  will  send  her  away.     The  people  know  it  and  are  glad. 

A  stranger  comes  to  the  house  and  yawns.  He  had  given  her  to 
understand  that  she  was  idling  away  her  time  and  now  must  be  sent 
away. 

"While  she  was  yet  at  home  she  read  in  a  newspaper  that  a  girl  in 
Basel  had  fallen  down  the  steps.  Delusion  :  the  reporter  would  give 
her  to  understand  that  in  her  former  position  she  had  not  cleaned 
the  steps  well. 

The  patient's  heredity  is  not  bad.  Intellectually  and 
affectively  she  is  above  the  average.     If  she  had  been  a 


90 

man  she  would  have  had  a  good  chance  to  succeed.  Since 
puberty  she  has  lived  with  well  situated  relatives.  The 
illness  and  death  of  her  father  as  well  as  the  economical, 
not  stingy,  sense  of  her  mother,  early  turned  her  ideas  to 
income  and  position  in  life.  She  wanted  to  make  some- 
thing of  herself  and  she  had  a  right  to  this  on  account  of 
her  gifts.  On  this  account  the  sexuality  had  to  play  a 
minor  part.  Although  she  was  sexually  normal  and  was  a 
prett}'  girl  she  never  earnestly  thought  of  marriage  because, 
as  she  herself  said,  her  social  level  was  below  that  of  the 
man  who  would  correspond  to  her  wishes.  Fate  had  bound 
her  to  an  occupation  which  overtaxed  her  but  did  not  give 
play  to  her  mental  faculties.  She  could  not  get  away  from 
it  because  it  provided  for  her  and  her  mother,  and  they  were 
able  to  lay  by  a  little  mone37  every  year.  Thus  mentally 
and  physically  this  occupation  filled  her  entire  life. 

The  sickness  and  death  of  the  peddler  caused  difficulties 
which  although  in  her  fright  were  overestimated  were  not 
entirely  groundless.  In  her  anxiety  she  was  not  able  to 
see  every  thing  clearly.  The  certain  existence  which,  ac- 
cording to  human  reckoning,  the  shop  had  made  for  her, 
appeared  to  her  to  be  precarious.  Her  own  ability,  on 
which  she  had  secretly  placed  a  good  deal  of  hope, 
appeared  insufficient  to  cope  with  the  situation.  She  must 
come  to  misery.  Up  to  here  there  was  nothing  that  could 
not  appear  to  a  normal  person  in  a  similar  situation.  The 
only  difference  is  that  a  normal  person,  after  the  situation 
was  straightened  out  and  after  the  affect  has  passed  awa}r, 
would  correct  the  false  ideas.  The  patient  was  not  able  to 
do  this.  The  chief  reason  for  this  we  do  not  know.  There 
are,  however,  some  other  factors  which  certainly  renders 
correction  more  difficult,  because  they  give  rise  to  renewed 
affects. 

In  the  first  place  there  was  the  relation  to  the  rich 
relatives,  which  often  plays  a  great  role  in  normal  and  ab- 
normal cases.  Here  it  is  important  in  various  ways.  Some- 
thing like  envy  of  those  who  have  reached  the  goal  toward 
which  she  was  striving  could  not  be  lacking,  although  on 
account    of    the    faultless    character    of    the    girl    it    has 


91 

probably  remained  unconscious.  Then  these  relatives  were 
the  ones  who  could  help  her  if  they  would.  They  have 
really  done  much,  have  given  her  pecuniary  aid,*  but  the}'- 
can  not  make  the  two  women  rich  without  injuring  them- 
selves. Then  also  the  former  close  business  relation  to  them 
plays  a  great  role.  The  patient  had  got  along  very  well  but 
had  to  give  place  to  a  young  wife.  I  have  no  reason  to 
think  that  she  thought  of  marrying  into  the  better  position, t 
but  every  girl  would  have  thought  of  it  and  the  patient 
probably  did  not  leave  the  place  without  some  bitterness. 
She  lived  in  that  house  a  second  time  and  again  under  cir- 
cumstances which  must  have  aroused  her  emotions,  namely, 
during  the  dissatisfaction  in  the  famity  where  she  felt  her- 
self between  hammer  and  anvil,  and  where  she  saw  how 
people  who  were  near  to  her  quarreled  among  themselves. 
The  fact  that  she  had  to  witness  this  without  being  able  to 
help  caused  her  to  make  a  certain  self-examination  :  would 
she  not  have  been  able  to  help?  or  was  she  by  reason  of 
her  presence  a  party  to  a  quarrel?  or  did  not  the  relatives 
think  that  at  least  she  might  be  partly  responsible  for  the 
trouble  ?  All  these  things  have  fastened  themselves  in  her 
mind,  and  as  she  felt  things  getting  uncertain,  her  thoughts 
were  naturally  turned  to  her  relations  because  they  were 
the  ones  from  whom  alone  help  might  come.  Never  in 
her  life  had  she  injured  any  one,  and  these  relations  at 
the  most  could  only  imagine  that  they  had  been  injured  by 
her.  And  then  when  she  heard  some  one  say  that  there 
would  come  a  time  for  retribution  (to  her  J  it  was  clear  to 
her  that  these  people  had  a  reason,  even  if  only  an  imagin- 
ary one,  to  withdraw  their  assistance  and  indeed  to  actively 
persecute  her. 

A  second  important  factor  lies  in  the  fact  that  in  the  retired 
life  of  the  patient,  her  separation  from  the  people  to  whom  she 

*To  this  the  patient  who  had  copied  my  paper  remarked  that  she  herself 
thought  that  Herr  S.  was  indeed  very  good  but  that  he  only  helped  her  brother- 
She  expressed  her  opinion  of  this  to  him  quite  openly.  "  At  such  a  time  it  was 
clear  to  me  that  I  was  wrong.  Shortly  afterwards,  however,  I  thought  my 
former  opinion  was  right." 

t  Addition  of  the  patient  "  Neither  when  I  was  with  my  uncle  nor  at  an}7  other 
time  in  my  life  have  I  thought  of  bettering  myself  by  marrying.  I  always 
thought  that  that  was  impossible  and  I  never  really  considered  it.  My  ideal 
was  to  have  an  old  maid's  establishment  in  independent  circumstances." 


92 

belonged,  a  certain  feeling  of  estrangement  toward  the  en- 
vironment, conscious  or  unconscious,  could  not  be  lacking. 
People  always  act  toward  such  a  person  in  a  different  way 
than  toward  an  ordinary  person.  If  she  is  unfortunate  the 
people  who  have  always  regarded  her  as  peculiar,  must 
have  a  certain  malicious  joy.  From  this  comes  first  the 
fear  that  the  people  in  the  town  do  not  begrudge  her  mis- 
fortune, then  the  idea  that  the}'  help  to  increase  her  mis- 
fortune by  allusions  and  calumnies. 

The  exact  observation  of  the  objective  and  subjective  rela- 
tions at  the  time  of  the  origin  of  the  disease  shows  us  therefore 
nothing  more  tha?i  the  appearance  of  errors,  such  as  occur  to 
normal  persofis  tinder  analogous  affects  and  a  connection  of 
accidental  occurrences  to  a  thought  complex  which  is  kept  con- 
tinually  awake  by  affects  and  her  own  trends  of  thought,  just  as 
it  is  in  a  corresponding  normal  mental  processes.  The  patho- 
logical feature  is  only  the  fixation  of  the  error  so  that  it 
becomes  a  delusion,  and  then  the  further  extension  of  the  delu- 
sions so  that  it  finally  becomes  paranoia.  Whether  the  fixation 
and  extension  of  the  error  is  determined  by  a  special  innate 
or  temporary  disposition,  by  the  coming  together  of  many 
important  external  factors,  by  a  toxic  action  or  by  an  an- 
atomical change  in  the  brain,  is  yet  to  be  shown.  But  I 
hold  that  at  present  there  are  no  grounds  to  think  that  the 
affects  play  an}'  part  other  than  that  shown  in  the  above 
examples.  Naturally  I  would  not  wish  to  say  that  further 
experience  may  not  demonstrate  new  relations  of  the  affect- 
ivity  to  the  delusions. 

But  to  my  mind  there  is  no  question  that  the  positive 
part  of  my  conception  is  correct  and  also  that  the  affects  in 
this  way  really  determine  pathological  symptoms.  For  this 
I  would  adduce  the  following  unshakeable  reasons  : 

1.  The  same  mechanisms  act  even'  da}'  in  the  case  of 
normal  people  in  the  way  described,  why  not  also  with  ab- 
normal people  ? 

2.  In  the  cases  of  paranoia  which  I  have  been  able  to 
analyze  in  recent  years  (to  be  sure  not  very  many)  the 
same  cause  for  the  direction  and  content  of  the  delusions 
could  easily  be  proven.     It  was  always  through  the  affect- 


93 

ively  determined  errors,  which  spring  up  in  a  way  similar 
to  the  dairy  experiences  of  normal  persons,  and  which  are 
then  fixed  and  extended. 

3.  As  Dr.  Jung  will  soon  show,  the  delusions  and  many 
other  mental  s3^mptoms,  perhaps  I  might  say  all,  of  dementia 
praecox  can  be  traced  to  the  same  action  of  complexes 
associated  with  emotions. 

Case  II.  Commercial  clerk,  born  1865.  Father  alcoholic,  suicide. 
No  other  hereditary  taint.  Normal  child,  somewhat  retiring,  be- 
loved by  his  friends,  appeared  shy  but  considered  himself  a  little 
better  than  the  others.  Raised  by  his  grandmother,  who  spoiled  him 
and  gave  him  too  much  money.  Attended  the  primary,  secondary 
and  industrial  -schools  ;  then  three  years  apprenticeship  in  Italy  where 
he  loafed,  drank  much  and  spent  a  great  deal  of  his  time  with  women. 
Came  home  in  a  somewhat  dilapidated  condition.  Worked  eight 
years  very  well  in  a  telephone  business.  He  drank  quite  a  little  but 
was  regarded  temperate.  Afterwards  he  was  eight  and  one-half  years 
in  a  municipal  office,  where  he  performed  his  duties  in  an  examplary 
manner.  He  had  to  collect  the  taxes  of  a  large  village  and  was  very 
anxious  about  his  work,  and  once  in  1896  he  had  a  surplus  of  20  francs. 
He  thought  that  perhaps  some  one  had  placed  the  money  there  to  test 
his  honesty,  an  idea  which  is  not  very  uncommon  among  normal 
people.  He  let  the  matter  drop  and  thought  no  more  of  it.  At  the 
end  of  the  '90's  he  had  a  deficit  of  50  francs  which  in  spite  of  every 
effort  he  could  not  explain  and  which  the  municipality  silently 
accepted.     Nobody  uttered  a  word  of  displeasure  or  blame. 

In  1899  there  was  again  a  deficit  of  40  francs.  He  could  not  bring 
himself  to  tell  any  one  about  it  and  could  not  cover  the  loss  with  his 
own  money  because  he  had  used  it  all.  Then  the  idea  came  to  him  to 
record  the  tax  of  a  person  who  was  on  a  journey  for  seven  months 
instead  of  nine  and  use  the  surplus  to  cover  the  deficit.  Discovery  of 
the  irregularity  was  practically  excluded.  His  conscience,  however, 
tormented  him  and  he  feared  the  discovery  in  some  unusual  way. 
He  was  too  intelligent  to  think  that  one  would  see  the  crime  in  his 
face.  Yet  he  thought  it  was  possible  to  discover  the  traces  of  youthful 
sins  and  debaucheries  in  the  face.  And  he  had  committed  debauch- 
eries which  he  had  regretted  very  much  in  the  last  twenty  years.  The 
people  would  notice  this  and  they  could  conclude  that  a  man  who  had 
behaved  so  badly  in  his  youth  would  be  able  later  to  steal  money  en- 
trusted to  him.  The  jailer,  with  whom  he  often  came  in  contact, 
had,  through  his  calling,  the  tendency  to  ferret  out  every  thing.  He 
had  also  brought  out  what  the  patient  had  done  earlier  and  had 
spread  it  abroad.  Every  one  knew  it,  they  looked  upon  him  peculiarly 
and  smiled  at  him  without  reason.  In  the  newspaper  he  saw  a  con- 
tribution signed  S.  M. ,  which  referred  to  him.     These  letters  meant 


94 

-'  Saumensc/i."  The  new  municipal-secretary  wished  him  out  of  the 
"way.  Perhaps  some  one  had  taken  the  money  in  order  to  test  him 
and  he  had  stood  the  test  badly.  He  thought  the  people  even-where 
talked  of  things  which  related  to  him. 

Xow  he  understood  many  past  things  which  at  the  time  had  not 
impressed  him.  He  saw  by  many  indications  that  they  had  wanted 
to  test  him  for  a  long  time,  etc. 

Finally  he  could  stand  it  no  longer.  He  had  worked  very  hard 
(actually)  of  late  and  resigned  his  position  and  received  an  excellent 
testimonial.  He  then  was  under  treatment  for  several  months  but 
scarcely  improved.  Then  he  took  a  position  in  the  French  part  of 
Switzerland  but  could  not  stand  it  there  very  long.  They  made 
allusions  about  him  even-where,  ' '  it  was  as  if  every  clerk  knew  of  my 
former  life. ' '  He  went  to  the  Canton  of  Zug  where  he  remained  a 
year,  then  left  there  in  a  rather  dilapidated  condition.  He  had  drunk 
rather  immoderately  while  there  in  order  to  deaden  his  sorrows  but 
even  in  the  inns  the}*  made  allusions  about  him.  They  even  began  to 
accuse  him  of  crimes  reported  in  the  newspapers.  He  went  to  the 
police  and  demanded  investigation,  saying  that  he  had  committed  one 
crime  which  he  had  reported  to  his  superiors  before  he  went  away, 
and  that  he  was  innocent  of  all  the  rest. 

Thus  on  the  12th  of  November,  1908,  he  came  to  Burgholzli.  He 
bad  a  fairly  marked  tremor,  had  a  slight  lisp,  and  on  stronger  emo- 
tions he  stuttered,  otherwise  there  was  nothing  somatically  abnormal. 
He  related  his  sufferings  in  a  perfectly  clear  manner;  anxious, 
modest,  he  had  almost  a  cringing  manner.  He  rapidly  improved 
mentally  and  physically  in  the  institution  where  he  felt  safe.  He 
worked  industriously  and  skilfully  arranging  statistics  and  the  like. 
"When  he  had  no  writing  to  do  he  busied  himself  on  the  farm.  His 
delusions,  however,  remained  unshakeable.  On  the  16th  of  December, 
1903,  he  was  paroled.  He  was  going  to  work  in  the  business  of  a 
relative.  Three  days  later  he  voluntarily  returned,  saying  the  per- 
secutions had  been  resumed  and  then  his  behavior  remained  the 
same.  He  said  that  the  rich  relative  who  had  taken  him  away  and 
who  had  brought  him  up  and  even  now  looked  after  him  in  an  un- 
selfish manner,  was  a  pederast,  that  he  had  knowledge  that  the  patient 
knew  this  and  so  must  also  have  an  interest  in  getting  rid  of 
him.  The  intrigues  in  part  came  from  him.  Probably  he,  the 
relative,  himself  had  also  set  fire  to  his  barn  which  had  recently 
burned  down.  The  patient  now  recollected  that  eighteen  years 
previously  he  had  stood  at  the  deathbed  of  a  woman  who  was  very 
dear  to  him.  There  was  also  another  woman  there  who  hated  the 
sick  woman  and  this  woman  had  looked  at  the  physician  meaningly 
and  had  then  given  the  sick  woman  something  whereupon  she 
died.  Xow  he  knew  that  the  woman  had  been  poisoned.  The  patient 
gradually  became  quieter  in  that,  as  he  said,  he  would  wait  until  he 
was   taken   before  a  judge  or  was  accused  directly.     On  the  22d  of 


95 

April,  1904,  he  was  discharged.  Since  then  he  has  remained  ab- 
stainer and  has  worked  industriously  in  his  new  place  until  the 
factor}^  burned  down.  He  had  even,  for  the  first  time  in  his  life, 
saved  money.  February  24,  1905,  he  presented  himself  here.  The 
delusions  had  become  much  milder,  in  certain  cases  he  admitted  that 
he  had  erred,  in  others  he  accepted  the  possibility  of  a  mistake.  As 
one  declared  incompetent  he  had  much  trouble  in  finding-  another 
place.  Perhaps  this  is  the  reason  why  it  went  worse  with  him  a  few 
weeks  later.  Recommitment  was  spoken  of  but  it  was  not  necessary. 
Since  spring-  we  have  heard  nothing  of  him. 

In  the  whole  course  of  the  disease  there  have  been  no  hallucinations 
or  illusions. 

A  boy,  fairly  well  developed  intellectually,  tainted  by  an 
alcoholic  heredity  on  the  father's  side,  comparatively  weak- 
willed  so  that  he  loses  control  of  himself  in  bad  surround- 
ings, somewhat  spoiled  b3r  his  grandmother.  In  a  foreign 
country  he  had  committed  alcoholic  and  sexual  excesses 
which  he  had  afterwards  regretted.  He  then  worked  well 
for  seventeen  years  even  if  he  did  indulge  in  the  customary 
drink  habit.  He  was  well  liked  by  his  neighbors  and 
was  regarded  as  reliable.  A  deficit  in  his  cash  account, 
of  which  he  was  probably  not  guilty,  caused  him  to  con- 
ceal it  in  a  criminal  fashion.  There  was  a  certain  regret 
over  this  fact  and  the  old  self  reproof  over  his  life  in 
Italy  was  renewed.  The  latter  gives  occasion  for  ideas  of 
reference  which  are  not  infrequent  in  normal  people,  but  in 
this  case  they  can  not  be  corrected.  Paranoia  is  established. 
Another  set  of  delusions  is  formed  about  the  complex  of  the 
rich  relative  who  had  not  earnestly  helped  him  and  who  now 
should  look  after  his  affairs.  He  must  have  some  reason  to 
treat  him  in  this  manner.  He  is  therefore  also  a  criminal.* 
An  old  erotic  complex,  which  seemed  to  have  disappeared 
with  the  death  of  his  sweetheart  is  finally  connected  with 
the  delusions  and  is  expressed  in  the  poisoning  story. 

We  therefore  see  in  this  case  also  the  normal  expression 
of  the  affectivity  leading  to  definite  delusions,  in  which  the 
errors,  formed  in  the  usual  way,  can  not  be  corrected  and 
at  the  same  time  increase,  the  latter,  to  be  sure,  under 
the  influence  of  the  continuing  domination  of  the  same 
affects. 

*  A  hebephrenic  whom  we  have  recently  seen  in  a  medico-legal  examination 
had  formed  almost  identical  delusions  about  his  rich  relative. 


96 

Case  III.  Machine-engineer,  born  1855.  Father  and  grandfather 
on  the  father's  side  alcoholic.  Bodily  a  well-developed  handsome  man. 
As  a  boy  he  was  capable,  cheerful,  but  somewhat  sensitive  and  seclu- 
sive.  Studied  and  worked  five  years  in  a  large  machine  factory  and 
then  went  abroad.  His  brother  wished  to  go  to  the  Cape  of  Good  Hope 
and  traveled  to  Marseilles  in  the  hope  of  finding  a  ship  and  on 
the  way  he  met  the  patient.  The  latter  also  wished  to  go  but  stipu- 
lated in  a  cautious  way  that  the  brother  should  secure  places  on  the 
ship  in  Marseilles  and  then  notify  him  to  join  him.  On  notice 
from  the  brother  he  went  there  only  to  learn  that  the  latter  had  made 
a  mistake  and  that  Marseilles  was  not  a  good  shipping  point  for  the 
Cape.  He  then  worked  in  Geneva  and  in  England  and  in  1876  he 
came  back  to  Switzerland  to  perfect  himself  theoretically  in  a  techni- 
cal school.  He  had  high  ambitions  and  although  he  could  expect 
only  a  little  wealth  he  thought  of  making  himself  famous,  of  making 
an  invention,  and  of  having  a  factory  of  his  own.  He  hoped  "soon 
to  have  money  enough  for  that. ' '  In  the  last  Semester  he  exhibed  a 
drawing  in  the  hope  of  obtaining  recognition  but  no  one  noticed  it 
as  he  had  expected.  After  that  he  thought  that  the  teachers  were 
envious  of  him,  especially  after  he  had  won  a  wreath  at  the  shooting- 
match. 

Now  his  troubles  began.  He  left  school  and  found  a  place  in  the 
factory  where  he  had  formerly  worked.  However,  he  thought  he 
was  too  good  to  work  eleven  hours  a  day  for  others  and  concluded 
that  the  firm  wished  to  use  his  intelligence  and  his  discoveries, 
for  their  own  benefit.  He  went  to  England  but  felt  that  the  firm 
followed  him  there  and  taunted  him  with  the  fact  that  he  had  come 
from  "the  riff-raff."  From  now  on  he  traveled  restlessly  in  America 
and  England,  now  and  then  making  a  visit  to  his  own  home.  He 
found  everywhere  that  he  was  slandered  and  hindered  in  his  work. 
This  seemed  to  be  a  question  of  delusions  of  reference,  but  he  prob- 
ably also  heard  voices.  He  had  married  in  America  but  had  left  his 
wife  and  allowed  her  to  obtain  a  divorce.  In  the  middle  of  1890  he 
had  an  attack  probably  due  to  a  slight  apoplexy  (syphilis  not 
demonstrable).  In  1897  he  was  at  work  in  Zurich.  Although  his 
employers  were  pleased  with  his  work  (he  constructed  independ- 
ently) he  thought  he  was  persecuted  by  his  superiors,  that  these  had 
formed  a  plot  against  him  and  that  he  was  insulted  in  the  cafes 
and  even  slandered  by  persons  outside  of  his  windows.  The  patient 
resigned  his  position  and  did  not  immediately  find  another.  He 
became  more  and  more  persecuted  and  began  to  drink,  against  his 
custom.  He  became  confused,  surely  had  hallucinations  at  this  time, 
and  finally  in  despair  shot  his  persecutor  from  ambush. 

Since  then  he  has  been  in  Burgholzli.  He  regards  himself  as  an 
excellent  engineer  who  would  have  made  many  inventions  if  he  had 
only  been  left  alone.  He  has  invented  a  special  machine  for  making 
cogwheels  of   every  kind   which  is   practical.     But  he  goes  further. 


97 

He  claims  that  years  ago  he  had  denied  that  he  regarded  himself  as 
a  statesman,  a  lawgiver  or  a  founder  of  religion.  The  voices  or  the 
ideas  of  reference  evidently  had  referred  to  this,  but  he  now  says  they 
were  correct,  for  before  the  catastrophe  he  had  drawn  up  laws  for  a 
colony,  a  la  Freiland,  which  were  not  unreasonable  and  only  suffered 
from  the  ordinary  mistakes  of  the  best  of  such  schemes  for  world- 
happiness. 

In  the  institution  his  system  of  delusions  did  not  extend.  Only 
now  and  then  he  complained  that  some  one  had  accused  him  of  uran- 
ism. Hallucinations  were  not  demonstrated  with  certainty,  at  any 
rate  they  were  subordinate.  He  grumbled  continually  about  his  dis- 
charge, said  that  he  had  murdered  his  superior  on  account  of  his 
persecutions  and  that  he  had  regained  his  reason  immediately  after 
the  deed.  He  learned  Spanish  and  Russian  so  that  he  could  get  a 
position  in  another  country  as  soon  as  he  was  released.  He  also 
took  care  of  the  institution  printing-press,  but  had  almost  always 
to  be  urged  to  work. 

Once  while  walking  he  escaped  but  did  not  receive  money  from  his 
relatives,  as  he  had  hoped,  and  finally  came  back  from  France.  He 
did  not  have  the  energ}'  to  live  without  his  passport.  Leaving  his 
delusions  and  the  reactions  to  them  out  of  consideration  nothing  can 
be  observed  as  a  symptom  of  a  mental  disease. 

In  this  case  we  can  not  follow  the  development  of  the 
paranoia.  Yet  it  is  very  easy  to  find  the  root  of  the  delu- 
sions. The  patient  was  capable  and  his  intelligence  war- 
ranted the  most  beautiful  hopes.  He  had  the  highest 
ambitions.  In  opposition  to  this,  however,  stands  a  char- 
acter which  lacks  energy  and  he  is  handicapped  by  a  great 
sensitiveness.  Thus  we  see  the  young  man  make  up  his 
mind  to  go  to  the  Cape  when  he  saw  his  brother  going  there 
and  then  abandon  the  trip  on  account  of  some  small  diffi- 
culties. We  see  him  at  once  greatly  disappointed  when  a 
drawing  did  not  receive  the  recognition  he  had  expected. 
In  the  asylum  he  must  be  urged  to  work  and  when  he  had 
escaped  he  did  not  have  the  strength  to  maintain  himself. 
With  the  exception  of  the  criminal  act  which  he  committed 
in  a  state  of  temporary  confusion,  his  reactions  to  the  per- 
secutions were  nothing  but  a  continual  cowardly  flight. 
Thus  it  is  easil)r  understood  that  he  could  not  accomplish 
wThat  he  wished.  Since  he  was  sensitive,  grounds  were 
not  lacking  for  the  feeling  that  he  was  being  injured  by  other 
men  and    for    ascribing  to  these  his  failures.     And,  since 


the  abyss  between  the  wish  and  its  accomplishment  always 
remained,  these  ideas  were  continually  maintained,  and  the 
patient  became  paranoic. 

Case  IV.  Bookbinder,  married,  bom  1869.  Father  irascible,  an 
older  sister  temporarily  insane,  another  sister  a  liar  and  a  thief,  a 
step-brother  by  the  same  father  had  been  convicted  of  some  crime 
and  had  died  in  an  insane  asylum.  Was  always  a  dullard  and  in 
school  had  to  attend  one  class  two  years.  Later,  onanist.  In  earlier 
years  he  had  frequent  headaches  and  at  one  time  had  to  enter  a  hos- 
pital on  this  account.  Always  somewhat  irritable,  irascible,  some- 
times struck  his  wife,  but  afterwards  apologized.  Always  anxious, 
modest,  shy. 

Since  the  latter  part  of  the  80's  he  lived  with  a  catholic  common 
law  wife.  Since  he  was  an  orthodox  protestant  he  finally  concluded 
about  1892  to  marry  her,  but  afterwards  continually  regretted  it.  He 
felt  especially  guilty  toward  the  minister  of  his  church  who  had  con- 
firmed him  and  to  whom  he  went  every  Sunday  to  church,  because 
he  had  not  asked  his  advice  and  feared  him  on  this  account.  Two 
years  after  his  marriage  he  once  passed  the  minister  (who  dominates 
his  parishioners  and  is  a  master  in  religious  suggestion),  but 
did  not  recognize  him  until  he  had  passed,  then  took  off  his 
hat  but  believed  that  it  had  been  too  late  for  the  minister  to  see. 
Now  he  was  in  despair  that  the  minister  would  be  offended.  Soon 
it  seemed  to  him  that  his  fellow-workers  knew  that,  acted  differ- 
ently toward  him  than  formerly  and  laughed  at  him.  He  also 
thought  that  his  employers  would  not  advance  hiiu  on  that  account. 
He  remained  discontented  and  changed  his  position  several  times. 

It  was  not  until  six  years  later,  1900,  on  the  occasion  of  a  similar 
circumstance  that  he  became  worse.  He  was  speaking  one  day  v/ith 
a  fellow-workman  about  leaving  his  position  and  just  then  his  em- 
ployer came  into  the  room.  In  his  fright  he  forgot  to  greet  him. 
Now  he  was  scared  lest  his  employer  would  be  offended.  He 
received,  as  he  believed,  harder  work  and  was  blamed  more.  His 
fellow-workmen  noticed  that  he  was  not  considered  so  well  and  began 
to  annoy  him.  He  made  up  his  mind  he  would  never  again  fail  to 
greet  anyone.  From  caution  he  began  to  greet  strangers.  He 
believed  that  every  one  noticed  whether  he  greeted  them  or  not,  and 
finally  that  his  coming  was  telephoned  to  the  passers-by.  In 
the  course  of  the  next  two  years  this  became  worse  and  worse. 
He  imagined  that  the  people  did  not  hear  his  greeting  and  there- 
fore he  became  more  insistent  and  would  greet  the  same  persons 
several  times,  and  run  after  them  to  repeat  it.  He  now  began  to 
greet  his  wife  and  would  say  to  her  in  the  morning  on  awakening, 
with  gradually  increasing  repetitions,  "Good  morning,  Mrs.  Meyer." 
He  himself  began  to  think  his  acts  were  foolish,  but  since  he  was  con- 
vinced that  he  must  greet  people  he  began  to  think  that  God  had 


99 

imposed  the  greeting-dtity  on  him  in  order  to  punish  him  for  his 
sins,  the  onanism,  the  marriage  without  consulting  the  minister,  and 
especially  the  neglect  to  honor  his  superiors.  The  first  two  reasons 
were  rarely  and  only  incidentally  mentioned.  He  could  only  think  of 
his  duty  to  greet,  he  neglected  his  work  and  sat  for  hours  on  the  sofa 
thinking  of  his  misery.  He  became  more  irritable  toward  his  wife 
and  occasionally  threw  things  at  her.  Since  he  had  expressed  ideas 
of  suicide  he  was  brought  to  Burgholzli  on  the  8th  of  September, 
1903.  Here  he  showed  himself  as  a  timid,  excessively  modest,  unener- 
getic  man.  He  wept  much.  One  time  when  he  had  two  pollutions 
he  was  very  much  depressed.  He  had  before  entrance  received 
very  unnecessary  treatment  for  spermatorrhoea.  Quite  apart  from 
his  greetings  he  always  apologized  for  something.  He  excused 
himself  for  mistakes  which  he  thought  he  might  have  made  but 
did  not  remember  having  made.  He  even  took  the  part  of  other 
patients  who,  irritated  at  his  continual  greetings  and  hand-shakings, 
would  give  him  a  box  on  the  ear,  and  he  regarded  all  his  suffering 
as  the  deserved  punishment  by  the  Almighty.  He  thought  he  was 
insolent  when  he  said  that  he  had  learned  the  bookbinder's  trade 
or  that  he  was  a  bookbinder.  On  one  occasion  he  said  that  we  should 
tell  him  what  he  should  do  and  he  would  certainly  do  what  we  wished. 
It  was  not  possible,  however,  to  repress  his  persistent  greetings 
even  though  he  had  promised  dozens  of  times  to  curb  them.  He 
thought  that  we  and  God  desired  it  of  him.  When  he  saw  four 
buttons  somewhere  he  thought  that  it  meant  that  he  should  now 
greet  every  one  four  times.  Once  he  thought  that  it  would  be  enough 
if  he  greeted  a  few  times  less  than  it  had  been  shown  to  him,  but  he 
was  unhappy  afterwards  because  he  had  not  obeyed  God. 

Since  he  had  also  expressed  the  idea  of  suicide  here  it  was  quite 
difficult  to  place  him  properly.  He  had  to  be  kept  where  he  could  be 
watched  with  the  other  patients  and  then  he  did  nothing  but  greet 
them.  It  was  quite  impossible  to  always  protect  him  from  their 
blows.  If  he  was  kept  alone  in  a  room  he  worked  industriously, 
sewed  and  did  simple  copying  quite  well. 

On  the  street  he  had  often  thought  that  some  one  said  ' '  here  he 
comes."  Excepting  this  there  were  no  traces  of  hallucinations  or 
illusions.  The  affects  were  always  entirely  adequate  to  the  con- 
lent  of  thought  and  also  qualitatively  were  not  be}rond  normal 
limits.  Blocking,  the  feeling  that  his  thoughts  were  taken  away, 
sterotypies  or  other  signs  of  dementia  prascox  could  not  be  found, 
although  naturally  they  were  zealously  sought  for.  His  system  of 
delusions,  in  spite  of  its  foolishness,  was  built  up  quite  logically  and 
consistently.  He  himself  recognized  the  foolishness  of  the  greetings 
but  since  other  men  and  God  wished  it  he  resigned  himself  to  this 
fact. 

In  the  institution  he  also  showed  some  ideas  of  reference  besides 
his  chief  idea.     He  thought,  for  example,  that  when  an  attendant  left 


100 

that  it  was  on  his  account.  He  heard  some  one  say,  ' '  there  we  have  • 
it  again."  That  was  a  reference  to  his  pride.  If  an  untidy  patient 
was  cleaned  he  felt  that  in  some  way  he  was  concerned. 

He  gradually  pulled  himself  together  and  could  be  taken  home 
occasionally  to  see  how  he  got  along  and  was,  on  April  6,  1904,  defin- 
itely discharged.  At  home,  after  a  short  time,  the  old  trouble 
recurred.  He  especially  annoyed  his  wife  by  continually  greeting 
people  who  came  into  the  shop  and  in  that  way  drove  them  away. 
From  December  13,  1904,  till  May  14,  1905,  he  had  to  be  kept  in  the 
institution  and  since  then  he  can,  with  difficulty,  live  with  his  family. 

In  this  case  the  diagnosis  is  not  so  plain  as  in  the 
other  cases.  The  continual  greeting'  looks  very  much  like  a 
stereotypy.  But  it  can  be  easily  differentiated  from  the 
stereotypies  of  dementia  praecox.  It  does  not  represent  an 
abbreviated  action  of  emotional  value  which  is  more  or  less 
unconsciously  and  automatically  performed  even  when  the 
reason  for  it  is  no  longer  present.  The  act  remains,  from 
first  to  last  perfectly  conscious  in  all  its  parts,  in  its  motives 
and  its  execution.  It  is  the  logical  consequence  of  a  delu- 
sion, and  if  the  latter  be  assumed  a  normal  man  would  act 
in  the  same  way  as  the  patient.  Through  its  premises  it 
is  as  well  founded  as  the  fact  that  a  person  in  a  high 
position  must,  on  every  drive  through  the  town,  answer  the 
greetings  of  the  public. 

The  impression  of  stupidity  which  the  behavior  of  the 
patient  causes  is  not  so  easy  to  connect  with  a  simple  par- 
anoia. The  picture  reminds  one  very  much  of  the  foolish 
acts  of  a  hebephrenic.  Yet  I  would  like  to  emphasize  the 
fact  that  this  can  also  be  explained  on  other  grounds: 
The  patient  was  never  very  intelligent.  In  the  public 
schools  he  had  to  attend  the  same  class  twice.  His  whole 
behavior  bears  the  stamp  of  heaviness  and  thick-headedness. 
The  continual  greeting  is  not  so  perverse,  for  one  of  his 
intelligence,  as  it  would  be  in  an  intelligent  man.  To  this 
must  be  added  the  fact  that  the  patient  knows  the  foolish- 
ness of  his  acts;  only,  according  to  his  logic,  which  in  this 
case  is  correct,  it  is  not  the  greetings  themselves  which  are 
foolish,  but  the  fact  that  God  and  other  men  require  such 
a  thing  of  him.  We  must  not  forget  that  occasionally  God 
requires  from  intelligent  people,  acts  which  to  us  appear 
just  as  senseless,  as,  for  example,  that  a  pilgrim  must  crawl 


101 

on  his  knees  from  the  spot  where  he  sees  the  church 
steeple  to  the  church  of  the  place  of  pilgrimage .  Compulsive 
acts  which  are  no  more  intelligent  and  yet  often  are  seen 
in  very  intelligent  persons  must  also  be  remembered.* 
I  do  not  believe,  therefore,  that  one  has  any  right  in  this 
case  to  conclude  that  the  patient  is  deteriorated,  because  an 
individual  act,  though  frequently  repeated,  gives  one  the 
impression  of  dementia.  If  we  add  that  after  a  rather  long 
observation,  we  have  not  found  the  slightest  sign  of  demen- 
tia praecox,  the  probability  of  the  presence  of  this  disease 
is  practically  nil.  Nevertheless,  the  thought  can  not  be 
totalby  repressed  that  it  is  a  case  in  which  the  signs  of 
dementia  praecox  may  manifest  themselves  later  or  that 
they  are  now  masked  by  the  continual  monotonous  act. 
Since,  however,  the  mechanisms  of  the  formation  of  delu- 
sions in  dementia  praecox  are  the  same  as  we  think  we  have 
shown  above  in  paranoia,  and  since  they  also  accountfor 
many  errors  of  normal  persons,  the  example  is  nevertheless 
instructive. 

A  slightly  imbecile,  very  shy,  obsequious  and  at  the  same 
time  deeply  religious  man  is  by  the  power  of  love  brought  to 
marry  a  woman  of  another  faith.  He  regrets  it  for  years  but 
can  not  leave  his  wife.  The  minister  who  had  confirmed  him 
and  with  whom  he  had  remained  in  contact,  the  represent- 
ative of  the  heavenly  anger,  is  a  mighty  personality.  Before 
his  marriage  he  had  always  had  the  feeling  that  he  should 
ask  this  man's  advice  but  he  had  never  dared  approach  him 
with  such  a  question.  He  passed  this  man  without  greeting 
him  and  the  fact  that  he  had  done  so  weighed  like  sin  on  his 
mind.  At  this  time  the  patient  may  have  concluded  to 
take  care  that  it  should  not  happen  again,  and  he  probably 
felt  a  tendenc}*  to  greet  too  much  rather  than  too  little. 
At  any  rate,  several  years  later  a  similar  incident  happened 
again.  This  time  it  was  not  his  heavenly  but  this  earthly 
salvation  that  was  concerned.  He  neglected  to  greet  his 
employer  just  as  he  was  speaking  of  changing  his  position. 
He  was  dependent  on  this  man  who  could  injure  him  by 

*  Naturally  it  can  not  be  a  compulsive  act  in  this  case.  The  patient  is  as 
-convinced  of  the  correctness  of  his  premises  as  only  a  paranoic  can  be. 
-Moreover,  the  general  delusions  of  reference  exceed  what  is  found  in  obsessions 
-and  it  is  all  built  up  as  a  logical  system. 


102 

giving'  him  a  bad  recommendation.  It  is  characteristic  for 
the  weakness  of  the  patient  that  he  did  not  leave  the  place 
but  stayed  and  allowed  himself,  as  he  thought,  to  be  tor- 
mented by  his  employer  and  fellow- workmen.  Therefore, 
the  anxious  affect  is  continually  fed  and  the  patient  can 
not  be  free  from  it  any  more,  and  the  delusions  have  time 
to  fix  themselves.     The  disease  becomes  incurable. 


In  these  examples  a  complex  of  ideas  associated  with  emo- 
tions forms  the  point  of  departure  for  the  delusions  and' 
perhaps  for  paranoia.  This  view  differs  but  little  in  prin- 
ciple from  Wernicke's  conception  of  "over-valued  ideas." 
A  small  difference  lies  in  the  fact  that  Wernicke  does  not 
sharply  separate  the  paranoic  disease-picture  with  its  pro- 
gressive development  of  a  delusional  system  from  other 
kinds  of  over-valued  ideas.  A  greater  difference  is  brought 
about  by  his  anatomico-physiological  conceptions  according 
to  which  the  molecular  changes  are  greater  in  perceptions 
associated  with  affects  than  in  ordinary  ones,  and  according 
to  which  disorders  and  other  changes  in  the  psychokym  are 
adduced  as  explanations.*  We  prefer  to  remain  in  the 
sphere  of  psychological  facts  since  the  physiological  pro- 
cesses are  too  little  known  and  since  such  hypotheses  are 
too  much  in  the  air. 

But  we  believe  that  we  differ  most  from  Wernicke  in  that 
this  author  places  the  affect-full  occurrences  almost  alone 
in  the  foreground,  while  we  place  beside  this  a  series  of 
lasting  predisposing  factors,  such  as  we  have  observed  in 
our  cases,  as  absolutely  necessary.  But  even  with  these 
causes  we  believe  we  are  yet  far  from  our  goal.  We 
are,  on  the  contrary,  convinced  that  in  the  majority  of  the 
cases  further  investigations  will  show  a  constitutional  predis- 
position, and  a  chain  of  Freud's  predisposing  occu?'rences. 
The  constitutional  predisposition  will  explain  why  these 
people  and  not  others  suffer  from  paranoia  and  Freud's 
complexes  will  tell  us  why  the  critical  events  have  brought 

*  Compare  P£eifer—Monatsc/ir.  f.  Neurologic  and  Psychiatrie  XIX.  p.  jo,  bo.. 
6s- 


103 

out  the  paranoia,  and  eventually,  why  the  developed  para- 
noia immediately  connects  itself  with  these  events. 

Similar  processes  are  very  frequent  with  healthy  indi- 
viduals. If  we  are  anxious  for  any  reason  a  mass  of  percep- 
tions and  other  occurrences  are  interpreted  in  the  sense  of 
the  affect.  In  a  merry  mood  we  take  everything  lightly  and 
often  notice  only  the  agreeable  and  thus  deceive  ourselves 
as  to  the  real  situation.  In  the  same  way  the  melancholic, 
in  whom  the  pleasureable  associations  are  inhibited  by  the 
depressive  affect,  uses  only  those  ideas  which  correspond  to 
the  depressive  affect.  Thus  errors  arise  in  the  more  pro- 
nounced states  of  this  sort  which  can  not  be  corrected  so 
long  as  the  affects  inhibit  the  opposing  ideas,  i.  e.,  so  long  as 
the  disease  remains  at  its  height.  That  is  indeed  the  most 
important  origin  of  the  depressive  delusions. 

In  these  examples  it  is  a  question  of  a  general  emotional 
state  of  some  duration  such  as  elation  or  depression.  But  an 
affect  which  is  connected  with  a  special  idea  complex,  may 
have  a  like  action  if  it  frequently  or  persistently  stands  in  the 
foreground.  Then  the  new  experiences  are  associated  with 
it  just,  as  in  the  other  cases,  they  are  associated  with  the 
exalted  or  depressive  ideas  and,  moreover,  further  associa- 
tions are  so  regulated  that  those  in  harmony  with  the  affect 
are  facilitated  and  the  opposite  are  inhibited.  This  leads 
to  errors  in  the  normal  and  to  delusions  in  the  abnormal. 
The  ground  for  the  domination  of  a  complex  may  be 
physiological  or  pathological. 

On  one  occasion,  when  I  was  reading,  I  had  an  intel- 
lectual feeling  that  I  saw  my  name  two  lines  below.  To 
my  astonishment  I  found  only  the  word  "  Blutkorperchen." 
Of  many  thousands  of  mistakes  in  reading  in  the  central  as 
well  as  in  the  peripheral  field  of  vision  this  is  the  worst  case. 
Usually  when  I  thought  I  had  seen  my  name  the  word  which 
had  given  occasion  for  the  mistake  was  much  more  like  it 
than  this.  Generally  almost  all  the  letters  of  my  name  had 
to  be  present  before  I  would  make  such  a  mistake.  In  this 
case  the  reason  of  the  '  'delusion  of  reference' '  and  the  illusion 
was  easy  to  trace.  I  was  reading  the  last  part  of  an  article 
about  a  kind  of  bad  style  in  scientific  works  from  which  I 


104 

did  not  feel  that  I  was  entirely  free. — A  student,  during-  his 
examinations,  received  an  invitation  to  dinner  from  one  of 
his  teachers.  The  latter,  as  I  can  bear  witness,  wrote  a 
totally  illegible  hand  and  this  caused  the  anxious  student 
to  read  instead  of  an  invitation  to  dinner,  a  notice  that  he 
had  failed  in  his  examination. — A  colleague  who  is  a  good 
psychological  observer  said  once,  that  according  to  his 
own  experience  and  observation  of  his  fellow-students, 
every  candidate  for  examination  suffered  from  delusions  of 
reference  toward  his  examiner. — A  woman  student,  an 
otherwise  very  clever  girl,  was  frightened,  during  the  ex- 
amination time,  by  every  man  who  wore  spectacles,  because 
she  thought  he  might  be  an  examiner. — A  father  whose 
absent  child  was  ill  thought  that  every  telegram  contained 
bad  news,  although  he  daily  received  business  telegrams. 

Bvery  complex  accompanied  by  affects  has  normally 
the  tendency  to  gather  about  it  new  experiences.  This 
tendency  to  association  must  be  due  to  the  fact  that  such 
complexes  occupy  us  much  longer,  that  the}'  are  more 
often  and  more  persistently  in  consciousness  than  others, 
and  therefore  furnish  greater  chances  for  association.  The 
affect  itself  increases  this  tendency  by  inhibiting  associa- 
tions which  are  contradictor}7,  thus  interfering  with  object- 
ive judgment  while  it  emphasizes  and  gives  greater  weight 
to  those  which  are  similar  or  can  be  construed  to  be  in  accord 
with  the  complex.  Thus  the  examination  candidate,  at  the 
critical  time,  only  thought  of  failing,  and  it  is  easily  under- 
stood that  when  he  received  a  letter  he  supposed  that  it  con- 
tained a  notice  of  his  failure.  His  anxiety  caused  him  to  read 
in  the  scrawl  of  the  examiner  the  dreaded  catastrophe,  exactly 
as  a  fearful  person  regards  a  stump  of  a  tree  as  a  robber. 

Similar  delusions  of  reference  are  very  frequent  in  melan- 
cholia. 

Our  paranoics  were  in  the  same  condition  at  the  time  of 
the  formation  of  their  delusions.  The  conclusion  that  the 
development  of  paranoic  delusions  is  essentially  the  same 
as  the  formation  of  errors  in  normal  people  is  therefore 
warranted.  For  their  genetic  explanation  we  need  no  other 
mechanism  than  that  which  we  alreadv  know  as  the  mode 


105 

of  action  of  the  affects.  We  must  especially  deny  the  necessity 
■of  assuming  in  addition  an  affect  of  suspiciousness,  a  disorder 
.of  the  apperception,  or  similar  hypothetical  constructions. 
But  in  this  way  only  is  the  origin  of  the  delusions  rendered 
clear,  not  the  genesis  of  paranoia.  For  if  we  ask  ourselves 
what  is  the  intrinsic  nature  of  paranoia  we  can  give  no  answer, 
but  I  think  that  no  answer  is  better  than  a  false  one.  Thus 
we  must  yet  ask  why,  in  certain  cases,  an  idea  accompanied 
by  affects  becomes  the  starting  point  of  paranoia;  why  the 
errors  caused  by  affects  are  corrected  in  most  of  the  other 
cases  but  not  here  ;  why  they  extend  in  paranoia  whereas 
in  normal  people,  although  they  may  not  be  corrected,  they 
do  not  increase;*  and  finally  what  causes  the  inability  of 
correction  and  the  tendency  to  extension  of  paranoia. 

We  can  cover  our  lack  of  knowledge  by  the  word  ' '  dis- 
position." With  the  same  physical  and  mental  trauma 
one  person  develops  an  incurable  psychosis,  another  a 
transient  hysteria,  another  a  momenta^  fright.  Wherein 
lies  the  difference  ?  The  nervous  system  of  one  person  re- 
acts to  the  traumata  in  an  entirely  different  manner  than 
does  that  of  another  person.  Moreover,  some  accidental 
influence,  fatigue,  poor  nutrition,  may  alter  the  disposition 
momentarily.  Or  ideas  which,  during  some  accident,  happen 
to  dominate  the  patient  may  predispose  him  to  the  elabora- 
tion of  the  impressions  in  a  pathological  sense.  All  these 
possibilities  must  be  taken  into  consideration. 

*  It  not  infrequently  happens  that  under  the  influence  of  an  affect  errors  are 
not  only  made  but  fixed  in  healthy  people.  The  errors,  or  we  might  say,  delu- 
sions can  not  then  be  differentiated  from  the  false  or  insufficiently  founded  ideas 
of  the  different  kinds  of  superstitution  which  are  produced  by  suggestion.  The 
difference  from  paranoia  is  that  they  do  not  extend.  Thus  they  rarely  have 
much  influence  on  the  actions  of  the  individual.  Sometimes,  however,  they 
dominate  the  thoughts  to  such  an  extent  that  one  must  regard  them  as  patholog- 
ical. The  following  case  is  interesting,  though  we  are  dealing  with  an 
acquired  emotional  disposition.  A  high  state  official  in  the  revolution  at  the 
time  of  Napoleon  remained  true  to  his  sovereign  while  all  his  colleagues  forgot 
their  oaths  and  turned  toward  the  new  sun.  He  was  therefore  imprisoned. 
After  the  restoration  he  was  completely  forgotten.  His  unprincipled  col- 
leagues were  ashamed  of  their  actions  and  therefore  hindered  the  revision  of 
his  sentence.  After  about  twenty-five  years  his  family  succeeded  in  getting 
him  free.  He  appeared,  as  a  rule,  to  be  normal.  The  miserable  wrong  which 
had  ruined  his  life  had,  however,  not  passed  over  him  without  leaving  a  trace. 
From  time  to  time  he  fell  into  attacks  of  rage  which  could  only  be  cut  short  by 
all  his  family  assembling  as  soon  as  possible  and  begging  his  pardon  on  their 
knees  ;    it  was  not  necessary  for  them  to  give  any  reason  for  their  apologies. 


106 

For  the  majority  of  psychiatrists  the  question  of  disposi- 
tion in  paranoia  is  already  settled.  For  them  it  is  a  matter 
of  an  innate,  generally,  a  family  disposition.  At  present, 
however,  neither  the  personal  nor  the  family  disposition  is 
proven.  More  than  one  case  of  paranoia  in  the  same 
family  is  rare.  I  know  of  no  general  disposition  that  is 
necessary  for  the  origin  of  paranoia.  Xaturally  psycho- 
pathic families  are  more  inclined  to  ps3rchoses  but  not  partic- 
ularly to  paranoia.  Many  speak  of  "  degeneracy,  "  yet  this 
again  is  not  definite,  but  comprises  several  concepts  which 
are  not  well  circumscribed.  As  opposed  to  this  we  must 
insist  that  in  paranoia  "  degeneracy, "  even  if  existing,  can 
not  be  the  same  as  that  of  idiocy  or  imbecilit\'.  In  these 
conditions  (the  latter  at  least  consists  of  many  etiological 
groups)  we  have,  besides  the  poor  mental  development, 
also  a  tendency  to  bodily  defects.  The  so-called  signs  of 
degeneracy  are  found  nowhere  so  frequently  as  in  epilepsy 
and  idiocy.  It  is  entirely  different  in  the  case  of  paranoia. 
The  majority  of  cases  consist  of  men  who  are  bodily  and 
intellectually  well  developed.  Among  the  paranoics  which 
I  have  seen  there  are  very  few  who  could  be  called  bodily 
or  mentally  degenerate.  "•  There  were,  as  far  as  I  can  judge, 
more  well  developed  individuals  among  them  than  among 
the  normal. 

The  disposition  to  paranoia  is  therefore  yet  to  be  dis- 
covered. 

If  it  is  a  psychological  one,  it  naturally  does  not  need  to 
be  a  definite  one,  for  in  such  a  complicated  mechanism  as 
the  mind,  most  results  can  probably  be  reached  along 
different  lines.  If  we  assume  that  certain  emotional  dispo- 
sitions such  as  we  have  found  in  the  first  three  cases,  lead 
more  easily  than  others  to  a  certain  conflict  with  fate,  then 
this  may  furnish  one  of  the  most  important  of  the  predispos- 
ing causes;  just  as  the  struggle  for  existence  forms  the  most 
common,  but  not  the  only  ground  from  which  a  certain, 
indeed  the  most  frequent,  group  of  traumatic  psychoses 
spring.  The  struggle  with  fate,  as  the  diversity  of  the 
three  examples  may  show,  may  be  determined  by  different 
combinations  of  types  of   emotional  tendencies  and  char- 


107 

acter.  Even  the  influences  of  external  occurrences  may 
be  lacking  or  may  be  very  important,  for  usually  (always?) 
a  psychic  trauma  is  necessary  for  the  development  of  para- 
noia, such  as  the  death  of  the  peddler  (Case  I)  or  remorse 
(Case  II).  Then  there  must  be  a  reason  why  the  delusion 
is  maintained  and  incurable,  and  perhaps  also  a  reason 
which  causes  it  to  gradually  extend.* 

These  factors  also,  as  far  as  we  know,  do  not  need  to  be 
uniform.  They  may  be  different  in  every  case,  or  may  be 
combinations  of  different  causes.  It  would  be  possible,  for 
example,  that  in  Case  II  the  patient  would  not  have 
developed  delusions  of  persecution  if  he  had  not  had  a  bad 
conscience  on  account  of  his  onanism,  which  he  thought 
was  discoverable  in  the  face  and  therefore  attracted  atten- 
tion. It  must  also  be  remembered  that  a  serious  experience 
which  produces  a  break  in  the  individual's  mental  exist- 
ence determines  a  lasting  disposition  exactly  as  in  the 
traumatic  neurosis  the  struggle  for  existence  continually 
maintains  the  feeling  of  being  ill.  Both  correspond  to  the 
vis  a  tergo,  which  according  to  Tiling,  {Neurol.  Psychiat. 
Wochenschr .  1901-2,  pages  443-444),  forces  the  thoughts  in 
a  definite  direction.  Our  first  patient  was  constantly  forced 
to  be  dissatisfied  with  her  position,  she  had  to  fear  for  years, 
that  she  would  lose  the  little  which  she  had  gained.  Case 
III  always  had  to  be  discontented  with  whatever  he  accom- 
plished or  did.  The  fourth  patient  always  felt  oppressed 
by  his  marriage  and  by  the  presence  of  his  superiors,  etct 

Beside  the  innate  functional  disposition,  I  can  not  totally 
exclude,  in  the  originary  paranoia,  a  superadded  disease  of 
the  sort  of  dementia  praecox.  Quite  apart  from  the  exten- 
sion of  the  concept  of  paranoia    outside  of  the    Krsepelin 

*  Incorrectability  is  naturally  not  extension.  A  great  many  suggested  errors 
are  incorrectable ;  they  do,  however,  not  extend  to  other  experiences  and 
therefore  do  not  lead  to  paranoia. 

tlf  such  psychic  traumata  alone  produced  paranoia  it  would  be  conceivable 
that  traumata  of  a  certain  strength  could  produce  paranoia  in  a  health y  brain. 
We  would  then  seek  in  vain  for  a  disposition  in  the  stricter  sense  and  even  in 
the  cases  where  a  mental  weakness  is  enumerated  among  the  causes  of  the  dis- 
order, this  weakness  would  not  be  the  determining  factor.  The  possibility  of 
the  existence  of  a  monomania  in  the  old  sense  could  then  not  be  excluded. 

This  is  not  the  place  to  discuss  the  existence  of  monomanias  and  the  over- 
valued ideas  which  are  contested  with  more  feeling  than  proofs.     Yet  I  can  not 


108 

school  it  is  not  improbable  that  a  part  of  the  cases  grouped 
by  some  as  paranoics  are  hebephrenics  in  whom  the  disease 
process  has  not  gone  so  far,  and  I  am  not  sure  whether  such 
a  thing  could  not  happen  to  a  faithful  follower  of  Krsepelin. 
The  case  of  Schneider's*  which  Kraepelin  himself  recog- 
nized as  paranoia  seems  to  me  to  be  such  a  one.  If  in  such 
cases  the  diagnosis  of  dementia  praecox  is  not  made,  the 
disease  process  must  be  so  little  pronounced  or  so  nearly- 
healed  that  we,  with  our  present  methods,  can  not  demon- 
strate any  specific  signs  of  dementia  praecox  while  the 
further  development  or  at  least  the  extension  of  delusions 
is  yet  possible. 

Against  the  generalization  of  such  an  idea  there  is  only 
the  fact  that  with  caution  one  scarcely  ever  has  to  change 
the  diagnosis  of  a  long -observed  case  of  paranoia;  while  if 
many  cases  of  paranoia  were  non-advancing  hebephrenics 
it  would  frequently  happen  that  a  later  progress  would 
manifest  the  dementia  praecox.  Nevertheless  I  desired  to 
call  attention  to  the  possibility  because  it  shows  us  that 
some  anatomical  or  chemical  changes  might  cause  paranoia. 
But  in  that  .case  we  would  have  to  assume  that  the  process 
would  have  to  be  one  that  does  not  lower  the  general 
intelligence,  for  if  one  does  not  make  the  absurdity  of  the 
delusions  the  criterion  for  the  general  intelligence,  one 
finds  in  the  genuine  paranoic  no  mental  weakness  in  any 
mental  operations  which  do  not  concern  the  system  of  de- 
lusions. But  to  assume  deterioration  on  account  of  some 
absurd  ideas  is  opposed  to  all  experience.  We  only  have 
to  remember  what  absurdities  are  committed  and  believed 
in  the  religious  and  political  spheres  by  very  intelligent 
people,  or  of  the  power  of  suggestion  which  ignores  logic, 
or  of  the  absurdity  of  our  dreams,  etc. 

avoid  calling  attention  to  the  fact  that  it  is  inconsistent  to  deny  the  possibility 
of  such  things,  so  long  as  we  regard  patients  with  hysteria  or  obsessions  as  not 
insane.  Therefore  it  seems  to  me  that  if  the  disposition  which  leads  to  hysteria 
and  obsessions  does  not  appear  important  enough  to  cause  one  to  think  the 
whole  mind  affected  we  have  no  more  reason  to  regard  the  disposition  to 
paranoia  as  a  general  mental  disorder.  The  most  evident  errors  can  be  sug- 
gested to  healthy  individuals  and  we  have  seen  that  the  power  of  the  affects  is 
identical  with  that  of  suggestion.  Moreover,  according  to  our  present  knowl- 
edge, it  is  not  excluded  that  paranoia  can  be  produced  by  an  accidental  sugges- 
tion or  by  an  affect  in  people  who  can  not  otherwise  be  called  mentally  ill. 
*  AUgem.  Zeitschrift.  f.  psych.  Bd.  60,  page  65. 


109 

To  be  sure  there  is  a  kind  of  "  dilapidation  "  in  paranoia 
but  it  is  different  from  deterioration.  It  is  the  condition 
which  we  find  in  all  people  who  only  think  and  act  in  one 
direction.  This  is  best  illustrated  in  hospital  residents  who 
on  account  of  some  bodily  ailment  hear  and  say  the  same 
thing  for  years.  It  is  also  shown  in  people  who  outside 
their  occupation  exercise  their  minds  only  at  a  favorite 
table  in  the  cafe,  or  in  women  with  a  one-sided  or  no  occu- 
pations. It  forms  an  integral  part  of  that  which  Moebius 
designates  by  the  name  of  "  Physiological  feeble-mindedness 
of  women." 

Furthermore  the  energy  of  paranoics  may  diminish  as  in 
other  people,  and  they  may  then  act  differently  than  they 
think  or  even  speak.  Or  they  may  develop  an  atrophy  of 
the  brain  by  which  an  easily  recognized  dementia  senilis  is 
added  to  the  paranoia.  Moreover  congenitally  weak- 
minded  people  may  become  paranoic  and  naturally  remain 
weak-minded,  or  a  paranoic  may  at  the  same  time  be  an 
epileptic  ( such  cases  are  described  though  they  do  not 
meet  the  newer  demands  of  diagnosis  )  and  then  an  epileptic 
dementia  may  be  added  to  the  paranoia.  I  have  not  seen 
other  forms  of  dementia  in  paranoia. 

To  the  affective  we  must  also  add  the  intellectual  dis- 
positions in  paranoia  which  appears  in  some  cases  to  be  the 
most  important  factor.  A  certain  vagueness  of  thinking 
must  favor  the  origin  of  delusions.  We  especially  expect 
to  find  such  defects  at  the  bottom  of  the  disease  in  paranoia 
quaerulans  and  in  megalomanias.  I  had  to  give  testimony 
in  the  case  of  a  world-reformer  who  played  a  great  role, 
as  far  as  the  German  tongue  is  heard.  I  was  in  doubt  for  a 
long  time  which  I  should  call  him,  a  paranoic  or  an  im- 
becile. The  confusion  of  his  system  of  delusions  which  he 
himself  could  not  clearly  grasp,  as  well  as  the  confusion  of 
his  ideas  generally,  caused  me  to  place  the  intelligence- 
defect  in  the  foreground.  The  man  presented  a  certain 
system  in  his  delusion  of  grandeur,  but  his  writings  clearly 
showed  that  the  indistinctness  of  the  ideas  together  with  a 
very  active  temperament  had  given  rise  to  the  delusions. 
Since  the  patient  could  not  circumscribe  his  ideas  it  was 


110 

possible  for  him  to  subordinate  all  that  occurred  to  him  to 
the  "  principle  of  contrast"  and  on  this,  as  well  as  other 
vague  ideas,  he  built  his  system. 

In  the  case  of  the  assassin  of  the  Russian  ambassador  in 
Bern,  on  the  other  hand,  I  felt  justified  in  diagnosing  para- 
noia since  he  had  built  his  delusion-system  as  consistently 
as  was  possible  with  his  vagueness  of  thought,  for  the  vague- 
ness was  not,  as  in  the  first  case,  the  cause  of  the  delusions 
so  that  the  whole  system  was  built  up  from  such  indefinite 
concepts,  but  the  indefinite  concepts  made  it  impossible  for 
the  patient  to  sufficiently  grasp  the  rights  of  others,  which, 
in  turn,  together  with  a  marked  affectivity  gave  rise  to  the 
origin  of  the  delusion  of  persecution.  These  were  very 
simple  and  could  therefore  be  as  clearly  conceived  as  in  the 
case  of  other  paranoics. — We  have  in  the  asylum  now  a 
paranoia  quaerulans  in  whom  the  indistinctness  of  the 
ideas  clearly  helped  to  form  the  delusions. 


If  we  always  find  emotional  complexes  at  the  bottom  of 
paranoic  delusions  we  must  then  be  able  to  divide  the  different 
kinds  of  the  disease  according  to  the  different  complexes. 
While  I  am  far  from  claiming  that  this  can  adequately  be 
done,  the  following  remarks  may  nevertheless  be  of 
interest. 

The  majority  of  persons  wish  to  get  ahead  in  life,  but 
even  the  most  fortunate  find  many  hindrances.  Those 
which  lie  in  circumstances  and  not  in  persons  must  lead 
either  to  resignation  or  to  self-destruction  when  they  are 
insurmountable.  Furthermore,  difficulties  which  are  not 
caused  by  our  fellow  men  do  not  arouse  our  feelings  as 
those  which  can  be  ascribed  to  some  person.*  When  bad 
weather  interferes  with  an  excursion  we  had  planned  we 
are  annoyed,  but  we  seek  some  other  pleasure.  But  if  the 
meanness  of  a  rival  is  the  cause  of  a  disappointment,  then 
we  are  apt  to  get  seriously  angry.  Thus  the  complex  of 
being  ill-used  can  refer  almost  only  to  persons,  and  must 

*  Perhaps  the  obstacles  which  are  within  ourselves  are  felt  the  most ;  e.  g.  the 
conflict  between  high  aims  and  insufficient  energy,  etc.    (Corap.  Case  III). 


Ill 

lead  to  delusions  of  persecution.  This  mode  of  origin 
which  we  have  assumed  also  explains  why  delusions  of 
persecution  are  the  most  frequent  type  seen  in  paranoia. 
Every  one  who  wishes  to  advance  has  opportunities  of  feel- 
ing himself  wronged. 

As  the  opposite  of  the  delusions  of  persecution  are  usually 
regarded  the  delusions  of  grandeur;  the  contrast  to  the  feel- 
ing of  being  persecuted  is  the  feeling  of  progress.  Of  course 
the  feeling  of  progress  is  viewed  differently  from  the  feeling 
of  being  persecuted.  The  latter  refers  to  opposition  by 
others,  the  former  we  ascribe  to  ourselves  and  to  the  help 
of  our  own  qualities.  The  true  opposite  to  the  delusion  of 
grandeur  is  the  delusion  of  inferiority  which  we  see  in 
depressive  psychoses.  In  manic-depressive  insanity  the 
delusions  follow  the  oscillations  of  the  affects  and  thus  the 
delusions  of  grandeur  and  of  inferiority  vary  with  the 
emotional  state. 

The  delusions  of  grandeur  of  paranoia  are  limited  to  a 
few  spheres.  The  paranoic  scarcety  ever  fprms  a  bodily 
delusion  of  grandeur,*  as  does  the  exalted  paretic,  and 
within  certain  limits  also,  the  simple  manic.  The  paranoic 
delusions  of  grandeur  are  also  rare  in  the  sphere  of  ordinary 
competition.  As  our  examples  show,  too  great  pretensions 
in  this  direction  lead  to  delusions  of  persecution  through 
the  impossibility  of  fulfillment.  But  if  the  endeavor  is  in  a 
sphere  where  results  need  not  appear  at  once,  where  the 
essential  part  lies  in  the  preparation,  in  the  elaboration  of 
schemes  or  theories;  if  the  ambition  tends  in  the  direction  of 
scientific,  religious  or  political  aims,  then  the  real  difficul- 
ties which  arise  from  the  disbelief  of  others  come  only  in 
the  later  stages,  and  the  pleasure  in  such  elaborations 
may  remain  undisturbed  for  a  long  time.f  It  must,  more- 
over, not  be  forgotten  that   every  one  who  does  work  of 

*  Compare  hypochondria. 

t  The  number  of,  not  paranoic,  scholars  who  spend  all  their  lives  defending 
some  youthful  scientific  mistake  is  probably  fairly  great.  This  is  the  best 
demonstration  of  how  little  the  opposition  is  perceived.  And  the  case  is  even 
more  glaring  if  the  justification  is  expected  in  the  world  to  come.  Then  one 
may  aim  at  the  greatest  nonsense  in  this  world  without  the  uncomfortable 
feeling  that  one  is  making  a  fool  of  one's  self.  Perhaps  the  discovery  of  the 
N-rays  belongs  here.     Comp.  Jahrbuch  der  Naturwissenschaft  1904-5,  p.  50,  f. 


112 

this  kind  must  expect  opposition  and  have  a  certain 
pleasure  in  combatting  it.  For  this  reason  these  com- 
plexes are  not  apt  to  call  up  delusions  of  grandeur.  To 
be  sure,  it  lies  in  the  nature  of  things,  that  even  in  such 
individuals  the  false  judgment  of  their  own  powers  and  of 
the  problems  will  eventually  cause  bitter  disappointment. 
Therefore  we  find  that  in  megalomanics  whose  euphoria 
does  not  entirely  overshadow  every  thing,  delusioirs  of  per- 
secution are  apt  to  be  mixed  with  those  of  grandeur. 

The  idea  of  having  the  support  of  other  persons  is  not 
likely  to  develop  into  a  complex  in  our  sense.  If  the  con- 
viction is  based  on  facts  there  is  no  occasion  for  delusive 
imagination;  if  not,  then  the  idea-complex  must  act  in  the 
direction  of  a  delusion  of  persecution,  as  is  illustrated  in 
one  of  our  cases  by  the  delusions  against  the  rich  relatives. 
Somewhat  similar  to  the  idea  of  having  the  support  of 
others  is  the  idea  of  high  descent  which  probably  does 
occur  in  pure  paranoia.  Here  the  patient  very  early  gets 
into  conflict  with  reality  and,  therefore,  such  delusions 
scarcely  exist  without  ideas  of  persecution.  I  must  confess, 
however,  that,  in  recent  years,  I  have  seen  such  ideas  only 
in  paranoid  dements.  Perhaps  this  complex  is  rarer  in  our 
democratic  Switzerland  than  elsewhere. 

The  erotic  complexes  are  among  the  most  important.* 
Thus  the  delusion  of  being  loved  is  very  frequent  in 
paranoics,  generally  to  be  sure,  connected  with  social 
ambitions  so  that  the  one  who  is  loved  or  thought  to  be  in 
love  is  usually  of  a  higher  social  level  than  the  patient. 
Naturally  conflicts  then  also  arise  and  a  mixture  with  ideas 
of  persecution  is  very7  frequent.  Those  who  are  in  sexual 
relationship  with  one  of  the  other  sex,  but  who  are  un- 
satisfied, develop  as  a  result  of  their  complex  a  paranoic 
state  with  ideas  of  jealousy,  which  naturally  is  more  fre- 
quent in  women  than  in  men.  Under  many  circumstances 
jealousy  is  normal  in  a  marriage  relation  without  sexual 
satisfaction.  If  the  individual  is  too  much  dominated  by 
this  complex  which,  of  course,   is  associated  with  marked 

*  In  the  discussion  of  a  point  of  view  similar  to  ours  Lomer  (Neurol.  Centralbl. 
1905,  p.  944)  claims  that  the  "  briginare  Verliebtheit  "  is  analogous  to  paranoia. 


113 

affects,  the  transition  to  delusions  of  paranoia  is  easily 
understood. 

Another  very  important  complex  for  the  civilized  individ- 
ual is  that  of  bodily  health.  However,  an  over-rating  of 
health  finds  its  own  checks  so  that  a  delusion  of  this  kind, 
if  it  became  too  marked,  would  at  once  correct  itself. 
Nevertheless  I  wonder  whether  not  many  of  the  health  fad- 
dists, whom  we  often  find  as  adepts  of  certain  systems  of 
"Natural  ways  of  living"  are  not  suffering  from  a  mild 
paranoia,  with  the  delusion  of  grandeur  of  especially  good 
health.  But  since  such  a  condition  is  only  possible  in  mild 
forms,  and  then  does  not  essentially  interfere  with  adapta- 
tion to  the  environment,  it  would  only  rarefy  be  observed  by 
psychiatrists. 

The  complex  of  bodily  health  becomes  more  important 
when  it  makes  itself  felt  in  a  negative  sense,  it  leads  then 
to  hypochondriasis.  In  my  opinion  it  would  be  wise  to 
reserve  this  name  for  those  cases  which  do  not  deteriorate 
intellectually  and  which,  without  primary  signs  of  exhaus- 
tion, begin  insidiously,  show  remissions  but  are  essentially 
progressive,  in  short,  which  behave  in  every  way  as  par- 
anoics with  hypochondriacal  delusion-systems.  I  do  not 
know  why  this  disease,  which  is  rare  only  in  insane  hos- 
pitals, should  not  be  regarded  as  paranoia.  Unfortunately 
I  possess  no  observatious  which  covers  a  long  enough  space 
of  time  and  is  exact  enough  to  be  used  as  proof.  Never- 
theless, I  am  willing  to  wait  for  objections  to  this  view, 
which  is  not  entirely  new,*  though  the  paranoic  hypo- 
chondriac of  the  books  are,  as  a  rule,  cases  of  dementia 
praecox. 

Except  for  its  usually  more  acute  beginning  the  trau- 
matic neurosis  (psychosis)  in  its  most  frequent  incurable 
depressive  form  is  also  closely  related  to,  perhaps  identical 
with  paranoia,  because  even  if  we  assume  the  same  mech- 

*  The  psychogenic  origin  of  hypochondriasis  too  has  long  been  suspected 
among  others  even  by  Romberg,  who  regards  as  the  hypochondriacal  element  the 
increase  of  the  existing  sensations  and  the  excitation  of  new  ones  by  means  of 
ideas.  (Cited  by  Wollenberg,Centralbl.  fur  Nervenheilkunde  uiid Psych.  15,  VII, 
1905).  While  many  are  inclined  to  lay  stress  on  hyperesthesia  of  organs  and 
regard  the  direction  of  the  attention  as  secondary  I  prefer  to  assume  the 
reverse. 


114 

anism  of  origin,  the  struggle  for  indemnity  which  arises 
suddenly  would  naturally  produce  a  more  rapid  develop- 
ment than  the  factors  responsible  for  the  typical  paranoia 
which  act  much  more  chronically  ;  and  other  acute  psychi- 
cal traumata  may  lead  to  the  same  clinical  picture.  We 
have  at  present  a  very  excellent  instance  of  this  kind  in  the 
hospital ;  I  knew  the  patient  before  the  disease  began  and 
have  been  able  to  follow  her  case  for  years,  although  at 
times  only  from  a  distance. 

Nurse,  born  1848.  In  addition  to  other  sad  experiences  she  has, 
since  1872,  been  married  to  an  alcoholic,  jealous,  rough  husband  who 
ill-treated  her.  In  1876  she  received  news  that  her  sister,  who  was 
divorced  from  her  husband,  had  become  pregnant  and  had  produced 
an  abortion,  from  the  consequences  of  which  she  was  dying.  She  her- 
self had  in  former  years  allowed  herself  to  be  forced  into  sexual  rela- 
tionship with  the  sister's  husband  before  his  marriage,  when  he  was 
her  guardian.  Therefore  when  she  received  the  news  it  occurred  to 
her  that  she  was  also  indirectly  guilty  of  the  death  of  her  sister.  She 
was  afraid  to  go  alone  to  see  her  sister  but  took  her  brother  with  her. 
On  her  return  from  her  sister's  she  met  her  husband,  who  as  usual 
began  to  torment  her  with  his  jealousy.  On  the  ward  she  "did  not 
know  what  she  was  about. ' '  She  said  to  another  nurse  that  "  If  I 
become  sick,  then  just  say  that  my  husband  is  to  blame."  During 
the  night  she  had  a  chill,  temp.  39.6  C,  yet  two  days  later  she  was 
treated  as  a  simple  neurotic.  Since  then  she  has  presented  the  typical 
picture  of  a  traumatic  neurosis  with  terrible  pain  everywhere,  with 
inability  to  work  for  years,  although  on  suitable  mental  treatment  she 
has  had  several  remissions. 

Traces  of  delusions  of  persecution  by  physicians  and  nurses  who 
would  not  help  her  and  who  paid  no  attention  to  her  sufferings  were 
mixed  with  the  picture,  but  such  ideas  were  later  corrected,  and  in 
reality  several  physicians  did  regard  her  as  essentially  lazy  and  weak- 
willed  and  treated  her  accordingly  with  the  result,  of  course,  that  each 
time  she  became  worse. 

The  mechanism  of  origin  seems  clear.  The  husband 
whom  she  hated  must  be  guilty  of  her  disease  and  the 
blame  would  be  greater  if  she  was  very  ill  and  if  the  disease 
ruined  her  whole  existence.  She  was  about  in  the  same 
mood  as  a  child  who  could  not  get  its  father  to  buy  it 
gloves  and  then  stubbornly  says  that  "it  would  serve  you 
right  if  I  freeze  my  hands."  But  this  is  surely  not  all.  The 
throwing  of  the  blame  on  the  husband  had  a  much  more 


115 

important  source  than  mere  hate.  She  thought  then  she 
was  to  be  blame  for  the  misfortune  and  death  of  her  sister. 
Since  she  was  a  very  moral  person  (the  sexual  intercourse 
with  her  brother-in-law  was  performed  only  after  a  great 
moral  conflict  and  forced  from  her  by  a  threat  of  suicide) 
the  fact  must  have  tormented  her  very  much.  Now  her 
sub-consciousness  transferred  this  guilt  to  her  husband. 
Not  she  but  her  husband  would  then  be  to  blame  if  she  was 
miserable.  The  accusation  of  another  displaces  the  feeling 
of  one's  own  guilt.  Such  a  transference  in  a  way  eases  the 
conscience  as  I  have  seen,  many  times  in  nurses  and 
attendants  when  they  made  mistakes. 

A  special  form  of  paranoia  is  the'  paranoia  quaerulans. 
For  a  long  time  it  has  been  known  that  a  real  injustice  is 
often  the  occasion  for  the  onset  of  the  disease  *  and  accord- 
ing to  Storring  (Psychopath.  484)  delusions  of  persecution 
can  also  come  from  well-grounded  suspicions.  In  these 
cases  the  origin  of  the  delusion,  in  the  sense  of  our'  con- 
ception, is  easily  understood  and  it  is  not  necessary  to 
again  explain  this.  On  the  other  hand  it  might  be  well  to 
refer  to  the  fact  that  the  constant  attempt  to  get  justice  as 
we  find  it  in  paranoia  quaerulans  is  a  symptom  of  many 
diseases  and  occurs  also  in  people  whom  we  can  not  call 
insane  even  if  we  leave  out  of  consideration  justifiable 
attempts  in  that  direction.  According  to  my  experience  we 
find  this  symptom  most  frequently  in  dementia  prsecox,  next 
in  paranoia,  it  is  also  not  infrequently  seen  in  hypomania, 
and  sometimes  in  the  early  stages  of  general  paralysis. 
Then  there  are  people  who  can  not  be  called  insane,  but 
who  from  intellectual  limitations  or  from  excessive  sen- 
sitiveness can  not  comprehend  the  rights  of  others.  The 
latter  classes  are  in  many  cases  not  so  easily  separated 
from  the  paranoic    forms.      Naturally    there    must  be  all 

*  Even  a  lawsuit  which  has  been  won  may  give  rise  to  a  paranoia  quaerulans. 
(Siemerling  in  Binswanger  and  Siemerling,  Psychiatrie,  pg.  150).  Compare 
there  also  among  the  causes  of  paranoia  the  affective  ones:  imprisonment, 
strong  emotional  excitements  through  lawsuits,  disappointments  (p.  140).  Fried- 
mann  recognizes  cases  of  paranoia  following  actual  persecution.  Compare  also 
Kleist's  Michael  Kohlhas  as  an  example  of  paranoia  quaerulans,  the  genesis  of 
which  seems  fairly  transparent.  We  would  further  mention  the  delusions  of 
being  unjustly  imprisoned,  the  delusional  expectation  of  speedy  liberation  in 
imprisoned  paranoics  and  in  other  psychoses  influenced  by  imprisonment. 


116 

grades    of   transition    from    the    sane    to    the    quaerulant 
paranoics. 

In  the  foregoing  probably  all  the  complexes  which  may 
arise  in  a  civilized  environment  have  been  demonstrated  as 
possible  origins  of  delusions  with  the  single  exception  of 
the  desire  for  children.  In  the  ideas  of  katatonics  and  of 
the  general  paralytics  the  well  known  "cry  for  children" 
plays  a  great  part.  Why  not  in  paranoia?  Unfortunately 
I  can  not  answer  this  question  and  must  thus  leave  an  im- 
portant gap  in  my  proof.*  Perhaps  some  one  else  will  be 
more  fortunate  than  I  and  may  solve  this  difficult}*.  But  I 
do  not  feel  that,  on  account  of  this  incompleteness,  I 
should  throw  over  the  whole  view. 


There  yet  remains  for  us  to  clearly  state  our  view  about 
the  limits  of  paranoia.  According  to  Kraepelin  man)*  hal- 
lucinations speak  against  paranoia.  In  other  diseases, 
especially  dementia  praecox,  also  in  hysteria  and  in  the 
delusions  and  hallucinations  caused  by  affects  which  we 
find  occasionally  in  normal  people,  it  does  not  seem  to  be 
essential  whether  the  delusion  comes  to  consciousness  as  a 
thought  or  as  a  voice.  In  the  course  of  many  (not  all) 
paranoias  hallucinations  occur.  In  some  cases  they  are 
few,  in  others  the)*  appear  in  the  form  of  a  more  or  less  out- 
spoken hallucinatory  confusion  of  several  days  or  weeks 
duration.  But  there  are  also  cases  in  which  hallucinations 
preponderate  but  who  are  otherwise  exactly  like  cases  of 
true  paranoia  inasmuch  as  an  emotional  and  intellectual 
deterioration  can  not  be  demonstrated  for  many  years. 
I  must  admit  that  circumstances  have  not  allowed  me  to 
investigate  such  cases  over  a  sufficiently  long  period  of  time 
with  all  our  present  diagnostic  methods,  but  the  usual 
hospital  observation  in  a  great  number  of  cases  has  given 
me  no  reason  for  concluding  that  they  are  cases  of  dementia 
praecox,  even  if  it  is  easy  in  the  great  majority  of  instances 


*  The  paranoic  women  who  think  they  are  the  mother  of  God,  if  there  are 
such,  I  would  place  in  the  religious  forms.  Many  mothers  think  their  children 
are  persecuted  by  the  teachers.    Perhaps  some  of  these  may  be  paranoics. 


117 

which  were  formerly  called  paranoia,  to  demonstrate  the 
cardinal  symptoms  of  dementia  praecox.  It  seems  probable 
to  me  that  in  many  cases  of  true  paranoia  one  can  find  hal- 
lucinations, even  of  many  senses,  (even  those  of  bodily 
sensations )  and  that  between  the  clinical  pictures  of  para- 
noid dementia  praecox  and  paranoia  several  other  disorders 
will  be  found  to  exist,  but  as  yet  only  one  has  been  shown 
by  Krsepelin,  the  presenile  states  of  delusions  of  persecution. 
Here  is  yet  a  rich  field  for  observation.* 

In  spite  of  the  fact  that  in  the  different  forms  of  paranoia 
we  have  shown  a  connection  between  the  direction  of 
delusions  and  the  affective  complexes,  the  question  as  to 
whether  all  forms  of  paranoia  have  the  same  genesis  is  yet 
open.  If  paranoia  is  a  mere  functional  disease  caused  by  a 
special  combination  of  emotional  make-up  and  external 
experiences  we  can  bring-  them  together  under  this  point  of 
view  as  well  as  hysteria.  But  one  must  remember  that  the 
interaction  of  emotional  make-up  and  external  experiences 
also  dominates  the  formation  of  delusions  in  other  disorders, 
so  that  entirely  different  processes  may  lead  to  the  formation 
of  similar  delusions.  We  can  not  therefore  exclude  that, 
for  example,  the  delusions  of  grandeur  may  be  caused  by  a 
different  process  than  the  delusions  of  persecution  or  those 
of  the  paranoia  quaerulans,  not  only  so  far  as  the  affect  but 
also  so  far  as  assumed  anatomical  or  chemical  causes  are 
concerned.  We  may  thus  suppose  that  the  assumed  disease 
process  dominates  the  mood,  just  as  general  paralysis  leads 
to  euphoria  and  this  in  turn  to  delusions  of  grandeur. 

What  would  speak  for  a  purely  functional  nature  of 
paranoia  is  the  absence  of  intellectual  deterioration  as  well 
as  the  fact  that  the  disorder  can  be  explained  on  the  ground 
of  quantitatively  changed  physiological  processes.  On  the 
other  hand  the  incurability  might  be  adduced  as  speaking 
in  favor  of  anatomical  or  chemical  causes,  yet  we  have 
seen  that  the  mental  causes  act  for  years,  often  even  for  a 

*  LiiKaro  (L'ipocondria  pensecutaria,  lata  forma  tardiva  pella  demenza  para- 
noia'e :  Kiv.  di  patologie  new,  e  went,  IX,  1Q04)  has  advanced  the  idea  that  the 
severest  and  most  characteristic  signs  of  dementia  praecox  are  seen  in  the 
youngest  cases  at  a  time  when  the  mind  is  not  developed.  In  harmony  with  this 
would  be  the  fact  that  the  paranoid  forms  occur  usually  in  adult  life  and  show 
xelatively  few  "  katatonic  "  symptoms. 


US 

whole  lifetime,  and  Friedmann  is  even  inclined  to  question 
the  incurability.  It  would  be  very  desirable  if  he  were 
right.  Perhaps  the  conception  which  we  have  above  de- 
veloped may  give  a  point  of  departure  for  a  more  hopeful 
treatment.  Unfortunately  I  am  myself  at  a  loss  to  state 
how  such  therapeutic  measures  should  be  carried  out. 

SUMMARY. 

AFFECTIVITY. 

All  the  intellectual  processes,  which  are  designated  by 
the  term  feeling,  must  be  sharply  separated  from  affectivity  - 
The  intellectual  feelings  of  Xahlowsky  are  intellectual  pro- 
cesses ;  hunger,  thirst,  pain,  etc.,  seem  to  be  mixed  pro- 
cesses. They  contain  a  sensation  and  a  feeling  associated 
with  it  or,  better  expressed,  a  feeling  produced  by  it.  Other 
bodily  sensations,  such  as,  for  example,  the  sensation  of 
tension  of  our  muscles  have  still  other  relations  to  the  feel- 
ings, (  =  affectivity ),  because  they  not  only  influence  affect- 
ivity  secondarily,  but  also  are  dominated  by  it  and  so  are 
themselves  part  of  the  symptomatology  of  the  affects. 

Only  the  affectivity  in  a  narrow  sense  has  in  health}'  and 
morbid  conditions  the  recognized  actions  on  the  functions- 
of  the  body  <  tears,  heart's  action,  respiration,  etc.  I,  and  on 
the  inhibition  and  facilitation  of  the  thoughts.  In  general 
it  is  the  dynamic  force  which  determines  our  acts.  The 
reactions  to  an  isolated  sense-impression  are  by  it  general- 
ized over  our  whole  body  and  mind,  it  pushes  aside  oppos- 
ing tendencies  and  thus  gives  the  reaction  force  and  extent. 
It  determines  a  concerted  action  of  all  our  nervous  and 
psychic  organs.  It  also  increases  the  duration  of  the  re- 
action by  lengthening  action  directed  in  a  certain  way 
beyond  the  time  of  the  primary  stimulus.  It  is  the  cause  of 
a  great  many  dissociations  and  transformations  of  our  ego, 
of  certain  forms  of  deliria,  etc. 

The  affectivity  shows  a  certain  independence  of  intel- 
lectual processes  in  that  the  affects  can  be  transferred  from 
one  process  to  another  and  in  that  different  persons  react  so^ 
differently  to  the  same  intellectual  process  that  one  can  not 


119 

establish  a  form  of  affectivity.  Moreover,  the  develop- 
ment of  the  affectivity  in  children  is  entirely  independent  of 
that  of  the  intellect. 

Thus  there  must  be  different  types  of  reaction  to  experi- 
ences associated  with  affects.  Unfortunately  they  have  not 
yet  been  studied.  But  it  is  quite  possible  that  on  such 
peculiarity  depends  whether  an  individual  will  become 
hysterical  or  paranoic  or  acquire  some  other  functional 
disease. 

Attention  may  be  regarded  as  one  side  of  the  affectivity. 
It  directs  the  associations  exactly  in  the  same  way  as  do 
the  feelings  and  it  does  not  occur  without  affects.  In 
pathological  conditions  it  is  changed  in  the  same  sense  as 
the  feelings. 

In  children  the  feelings  may  so  plainly  replace  reflection 
that  the  result  of  the  affective  facilitations  and  inhibitions 
in  associations  does  not  differ  from  those  produced  by  com- 
plex logical  reasoning.  This  is  what  we  call  instinctive 
reactions. 

In  pathological  conditions  abnormalities  of  the  affectivity 
dominate  entire  clinical  pictures.  In  organic  psychoses 
the  affectivity  has  not  undergone  deterioration,  as  is  often 
asserted.  On  the  contrary  it  reacts  more  easily  than  in 
normal  persons.  The  deterioration  of  the  affectivity  is  not 
real  but  secondary  to  and  simulated  by  the  deterioration  of 
the  intellect.  If  a  complicated  concept  can  not  be  formed 
or  totally  comprehended  one  can  naturally  not  expect  an 
emotional  reaction  corresponding  to  it. 

It  is  similar  in  alcoholics,  while  in  epileptics  the  affec- 
tivity is  also  preserved  but  instead  of  the  lability  found  in 
organic  disorders  it  shows  marked  perseveration. 

In  idiocy  we  find  all  possible  variations  of  the  affectivity 
as  in  normal  individuals  but  in  much  wider  limits.  In 
dementia  praecox  the  affects  are  displaced  in  some  way  but 
their  expressions  may  still  be  demonstrated. 

SUGGESTION. 

Suggestion  and  affectivity  have  the  same  action  on  mind 
and  body,  and,  so  far  as  we  can  judge,  they  also  act  by  the 
same  means. 


120 

In  primitive  conditions  with  animals,  that  which  is 
suggested  are  only  affects. 

Suggestion  has  the  same  action  for  a  community  of  in- 
dividuals as  the  affects  have  for  the  individual,  it  insures 
unity  and  perseverance  of  actions,  and  produces  a  collective 
affect. 

Suggestibility  as  affectivity  is  developed  in  children 
before  intelligence. 

The  greater  the  feeling-value  of  an  idea  the  more  sug- 
gestive power  it  has." 

That  which  is  described  as  the  action  of  auto-suggestion 
can  just  as  correctly  be  described  as  the  action  of  affect- 
ivity . 

Suggestibility  and  affectivity  have  the  same  relation  to- 
attention  and  also  to  pain  sensations. 

The  knowledge  of  either  property  is  not  yet  so  advanced 
that  one  can  expect  to  bring  the  great  or  slight  suggesti- 
bility into  connection  with  the  presence  or  absence  of  a 
definite  kind  of  affectivity. 

The  suggestibility  of  a  crowd  is  for  many  reasons  greater 
than  that  of  a  single  individual. 

Suggestion  is  almost  never  entirely  pure,  uninfluenced 
by  other  mental  mechanisms. 

We  can  best  put  our  knowledge  of  the  two  properties  in 
one  sentence  by  saying,  Suggestibility  is  one  side  of  affect- 
ivity. 

PARANOIA. 

As  yet,  no  one  has  succeeded  in  deriving  paranoia  from  a 
pathological  affect.  Suspicion  especially  which  is  held  to 
be  the  basis  of  paranoia  is  not  an  affect.  It  does  not  occur 
in  all  forms  of  paranoia. 

A  general  and  primary  affect-derangement  is  not  demon- 
strable in  paranoia.  The  affect  disorders  which  we  plainly 
see  are  secondary  consequences  of  the  delusions. 

Xor  does  there  exist  in  paranoia  a  general  disorder  of 
perception  or  apperception,  or  a  general  change  of  memory 
pictures,  and  the  hypertrophy  of  the  ego  is  not  demon- 
strable as  a  regular  symptom  in  paranoia. 


121 

That  which  is  designated  by  the  term  hypertrophy  of  the 
ego  or  egocentric  character,  is  only  the  consequence  of  the 
fact  that  in  paranoia  a  complex  associated  with  strong  feel- 
ings constantly  dominates  the  mind.  Just  as  in  the  case  of 
normal  individuals  whose  mind,  for  some  affective  reason 
or  through  constellation  is  focused  on  some  definite  idea,  so 
do  here  ordinary  or  more  unusual  experiences  become 
associated  with  the  complex.  In  this  way  much  that  has 
no  relation  to  the  person  at  all  is  associated  with  the  com- 
plex and  thus  arise  delusions  of  reference  ;  and,  because  all 
complexes  associated  with  feelings  bear  a  close  relation  to 
the  ego,  the  latter  appears  pushed  into  the  foreground  and 
therefore  ' '  hypertrophic . ' ' 

Careful  analysis  of  the  genesis  of  delusions  shows  that 
under  the  influence  of  a  chronic  affect,  i.  <?.,  the  affect  which 
is  connected  with  the  above  mentioned  complex,  errors 
arise  in  exactly  the  same  way  as  in  normal  individuals  who 
are  emotionally  stirred  up.  The  errors  become  pathological 
when  they  can  no  longer  be  corrected  and  when  they  extend 
to  other  matters. 

What  is  the  fundamental  cause  of  this  we  do  not  know. 
It  may  have  a  chemical  or  anatomical  foundation  ;  but  the 
cause  may  also  be  "functional,"  because  the  affectivity  is 
increased  in  a  certain  direction  or  because  of  its  long  dura- 
tion or  because  the  affect  is  constantly  kept  alive  by  the 
circumstances  or  by  an  experience  which  has  produced  a 
lasting  impression. 

As  long  as  we  do  not  know  the  underfying  process  of 
paranoia  we  do  not  know  whether  the  concept  of  paranoia 
represents  a  disease  entity.  A  condition  of  delusions  of 
grandeur  and  one  of  delusions  of  persecutions  may  be  fun- 
damentally different  disorders.  On  the  other  hand  it  is 
possible  that  a  number  of  hallucinatory  forms,  which 
Krsepelin  does  not  class  with  paranoia,  may  be  identical 
with  the  usual  forms  of  paranoia. 


DATE  DUE 

JUL  9 

-1995  JUI 

.  *  u  ito 

w  yj 

vy»J 

Printed 
In  USA 

COLUMBIA  UNIVERSITY  LIBRARIES 


0037568116 


